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: 07-01-16 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 7492 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 8 8 3.322222 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 20 22 127.712698 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 28 30 131.034920 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 6 6.000000 $291.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.933333 $47.9200 $51.3500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 0.466666 $9.9600 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.744444 $9.3900 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 163 181 238.934125 $5149.0200 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 28.228571 $233.1700 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.955556 $24.1900 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 0.072222 $5.5700 $77.1100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.994444 $20.5600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 10 6.416667 $288.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 9 8.561110 $984.5200 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.677778 $133.8900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 22 23 241.799206 $12089.9600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 6 3.122223 $234.1700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 48 84 189.250790 $14193.7900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 119 216 262.926401 $19719.4300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 9 5.227778 $392.0900 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 51 76 91.703969 $6877.8100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 161 291 379.712115 $21073.9900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 58 59 239.544443 $13294.7200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 20 20 33.011111 $2475.8300 $75.0000
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Subtotal (Total Children Is Unduplicated) 387 1006 1745.282952 $97849.7200 $56.0700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 21 14.527777 $72638.5000 $4999.9700
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 3.294443 $164.7200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 58 58 34.460619 $1723.0100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 7.632540 $546.5600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 49 52 49.839687 $11463.2500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 146 183 713.508736 $35675.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 7 7.188889 $179.7200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 479 884 1948.309020 $97415.4400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 42 53 94.865078 $2371.6300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 12.711111 $635.5600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 1.494444 $74.7200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 5.766667 $144.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 14.366667 $718.3400 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 33 53 268.153969 $19661.0500 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 46 62 459.814285 $11495.3600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1110 2094 22721.838090 $1136091.9400 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1121 2939 24979.615376 $249796.1600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 2.838096 $202.7500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 7.428572 $424.9100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1 1 1.571429 $112.2600 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 4 1.177777 $76.5500 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 3 4 3.222222 $734.6600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
2 2 2.027778 $924.6800 $456.0000
SENS -V5264 EARMOLD 7 8 10.961109 $197.3000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 4.266666 $304.8100 $71.4400
TRAV -TRAVS Travel by mile 1 1 3.642857 $1.6200 $0.4500
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Subtotal (Total Children Is Unduplicated) 1136 6456 51376.523904 $1643875.1000 $32.0000
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Total 7492 53252.841776 $1741724.8100 $32.7100
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Number of Children (Unduplicated) With at Least One Authorization 1143