Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 5656 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 10 11 9.922222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 11 9.922222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 58 81 14.618031 $708.9800 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 3.506620 $44.2200 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 9 0.906848 $19.5400 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 3.183333 $26.2900 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 3.183333 $80.5700 $25.3100
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.246575 $11.4500 $46.4200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 3.000000 $62.0400 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 12.857143 $578.5700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 13.246184 $1523.3100 $115.0000
EXIT -EXIT EXIT ASSESSMENT 92 92 53.236987 $2661.8400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 2.021916 $151.6500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.010958 $0.8300 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 101 101 57.668480 $4325.1900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 47 47 47.616430 $3571.2600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 135 135 95.752039 $5314.2800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 53 53 11.736978 $880.3100 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.002740 $0.1400 $49.2700
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 6 6 1.075342 $54.9000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 22 22 7.979375 $407.3500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 8 9 1.989499 $101.5600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.098630 $5.0300 $51.0300
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 7.891977 $402.8800 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 9 10 2.323287 $118.6000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 0.367123 $18.7400 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 40 43 26.961052 $1376.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 9 9 2.146349 $109.5800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 7 1.814536 $92.6300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 0.558904 $28.5300 $51.0500
SCREEN-T1023 SCREENING 3 3 0.983333 $49.1700 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 0.520548 $26.5800 $51.0600
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 0.736986 $37.6200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 41 46 10.664077 $544.4100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 0.320548 $16.3700 $51.0600
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Subtotal (Total Children Is Unduplicated) 376 720 391.231640 $23462.2200 $59.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 63 84 17.103874 $85520.5000 $5000.0700
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 3.000000 $150.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 80 100 30.475563 $1523.7400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 7 8.216666 $205.4200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 370 557 1005.566010 $50278.2800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 10 21.228571 $530.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 91 127 221.050001 $11052.5100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 9.266667 $231.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 84 155.025566 $7751.2600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 8.394444 $209.8600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 278 360 626.798411 $31339.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 9.400001 $235.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 37 44 1541.428568 $38535.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 443 590 4303.403702 $215170.0600 $50.0000
INTR -T1013 INTERPRETER 22 29 148.761693 $7438.0700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 492 985 4766.902166 $47668.9700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 95 132 1077.754403 $76994.7500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 30.857143 $1765.0300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 138 184 1565.114288 $111811.6800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 5 34.999999 $2000.6000 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 0.389041 $88.7100 $228.0300
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 1 1 12.857143 $5862.8400 $456.0000
SENS -V5264 EARMOLD 3 4 15.246184 $274.4300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 123 162 1250.109589 $89307.7500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 7.285715 $101.1300 $13.8800
TRAV -TRAVS Travel by mile 557 1439 297524.167797 $132398.2600 $0.4500
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Subtotal (Total Children Is Unduplicated) 603 4925 314394.803205 $918446.8300 $2.9200
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Total 5656 314795.957067 $941909.0500 $2.9900
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Number of Children (Unduplicated) With at Least One Authorization 610