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 1806 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 1 2 2.000000 $97.0000 $48.5000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.500000 $10.3400 $20.6800
EXIT -EXIT EXIT ASSESSMENT 5 5 98.955555 $4947.7800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 16 6.550001 $491.2600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 46 48 18.411111 $1380.8300 $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 22 22 19.879365 $1490.9500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 60 61 35.796031 $1986.6700 $55.5000
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Subtotal (Total Children Is Unduplicated) 81 156 182.592063 $10442.3200 $57.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 2 0.055556 $278.0000 $5003.9600
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 1 1 0.477778 $109.8900 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 43 50 128.794443 $6439.7200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 224 329 373.262706 $18663.1600 $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 1 1 0.100000 $7.3300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 4.771429 $119.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15 17 155.776192 $7788.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 646 1207 5692.492877 $56924.9100 $10.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 1.255556 $572.5500 $456.0200
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Subtotal (Total Children Is Unduplicated) 647 1640 6383.886537 $92007.4000 $14.4100
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Total 1806 6587.469870 $102449.7200 $15.5500
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Number of Children (Unduplicated) With at Least One Authorization 653