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: 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 3070 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 3 3 1.055556 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 7 19.935714 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 10 20.991270 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 4 4.000000 $194.0000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 98 104 71.263493 $1535.7300 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.897619 $15.6700 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.283333 $7.1700 $25.3100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.500000 $10.3400 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 2.011111 $90.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 2.244445 $258.1200 $115.0000
EXIT -EXIT EXIT ASSESSMENT 5 5 98.955555 $4947.7800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.500000 $37.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 20 35 52.523015 $3939.2300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 56 106 65.721004 $4929.0800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.500000 $37.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 24 42 29.712699 $2228.4500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 78 140 107.024178 $5939.8300 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 6.285714 $348.8600 $55.5000
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Subtotal (Total Children Is Unduplicated) 171 454 443.422166 $24519.7500 $55.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 10 1.894446 $9473.0000 $5000.4100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.511111 $25.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 6 2.211111 $110.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 30 30 12.783333 $2940.1600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 43 50 128.794443 $6439.7200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 225 331 375.262706 $18763.1600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 13 14 9.650000 $241.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 6.100000 $305.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.027778 $1.3900 $50.0400
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 8.400000 $420.0000 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 13 19 67.660319 $4960.8700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 20 23 110.338096 $2758.4500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 648 900 5248.989700 $262449.3500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 646 1208 5695.226210 $56952.2400 $10.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.100000 $22.8000 $228.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 1.255556 $572.5500 $456.0200
SENS -V5264 EARMOLD 3 3 1.544445 $27.8000 $18.0000
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Subtotal (Total Children Is Unduplicated) 651 2606 11670.749254 $366463.8400 $31.4000
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Total 3070 12135.162690 $390983.5800 $32.2200
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Number of Children (Unduplicated) With at Least One Authorization 654