Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1819 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 2 2 0.511111 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 11 12 36.198412 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 14 36.709523 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 8.769047 $192.4800 $21.9500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.366667 $9.3600 $25.5300
EXIT -EXIT EXIT ASSESSMENT 6 6 125.238096 $6261.9100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 16 5.738887 $430.4000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 28 28 11.472219 $860.3900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.216667 $16.2500 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 8 13.619841 $1021.4900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 41 43 27.697616 $1537.2000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.011111 $0.8300 $74.9300
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Subtotal (Total Children Is Unduplicated) 58 107 193.130151 $10330.3100 $53.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 4 2.700000 $13500.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.244444 $62.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 18 5.938889 $296.9500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 39 47 131.044446 $6552.2300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 3.166667 $79.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 242 349 507.040476 $25352.0300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 18 24 22.049999 $551.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 5.533334 $276.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 3.133334 $156.6700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 6.133333 $153.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 14 99.923810 $4996.1800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 684 1226 6381.469044 $63814.7000 $10.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 1.511111 $716.6200 $474.2400
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Subtotal (Total Children Is Unduplicated) 685 1698 7170.888887 $116508.0100 $16.2500
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Total 1819 7400.728561 $126838.3200 $17.1400
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Number of Children (Unduplicated) With at Least One Authorization 690