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: 04-01-17 and 06-30-17 Date of Report: 08-05-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1925 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 4 4 1.488888 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 8 20.752381 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 12 22.241269 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 2 2.000000 $97.0000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.011112 $21.7900 $21.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.127778 $2.6400 $20.6800
EXIT -EXIT EXIT ASSESSMENT 8 9 10.761111 $538.0600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.127778 $9.5900 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 19 19 8.816671 $661.2800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 52 54 24.494456 $1837.1700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 1.477777 $110.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 27 27 13.288100 $996.6400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 62 63 29.210330 $1621.2400 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
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Subtotal (Total Children Is Unduplicated) 95 183 92.315113 $5951.7300 $64.4700
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.011111 $100.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 3 0.805556 $185.2900 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 52 58 144.836510 $7241.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 241 361 422.639993 $21132.0900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 12 12 10.515078 $262.8800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 2 2.144444 $107.2200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 1.011112 $50.5600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.033333 $75.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 2.833333 $141.6700 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 9.565080 $701.3200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 5 25.109524 $627.7400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 25 27 192.733336 $9636.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 694 1248 5985.512248 $59855.1500 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.122222 $7.9400 $64.9900
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Subtotal (Total Children Is Unduplicated) 695 1730 6803.872880 $100151.7400 $14.7200
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Total 1925 6918.429262 $106103.4700 $15.3400
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Number of Children (Unduplicated) With at Least One Authorization 703