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 4551 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 28 30 131.034920 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 3.000000 $145.5000 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.744444 $9.3900 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 2.233333 $48.1300 $21.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.994444 $20.5600 $20.6800
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 1 1 0.127778 $9.5900 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 35 36 31.594444 $2369.5800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 89 92 70.755554 $5306.6600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 2.194444 $164.5800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 30 30 45.276192 $3395.7300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 109 114 109.326191 $6067.6100 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.011111 $0.8300 $74.9300
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 163 312 511.734919 $29817.5000 $58.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 6 4.800000 $24000.0000 $5000.0000
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 1 1 6.071429 $434.7700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 1.961112 $451.0800 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 145 182 713.008736 $35650.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 7 7.188889 $179.7200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 479 882 1944.242353 $97212.1100 $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 6 6 14.081747 $1032.4800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 6 44.080952 $1102.0300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 37 44 617.180950 $30859.0600 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1121 2937 24971.848709 $249718.4900 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 0.433333 $28.1600 $65.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
2 2 2.027778 $924.6800 $456.0000
TRAV -TRAVS Travel by mile 1 1 3.642857 $1.6200 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1125 4209 28499.527874 $447526.7800 $15.7000
-------------------------------------------------------------------------------------------------------------------------------------
Total 4551 29142.297713 $477344.2800 $16.3800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1137