Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 8824 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 64 75 143.512698 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 0.955556 $35.3600 $37.0000
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Subtotal (Total Children Is Unduplicated) 66 77 144.468254 $35.3600 $0.2400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 40 45 44.371136 $2152.0100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.355555 $172.3000 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.022222 $18.3200 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $21.3500 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.022222 $12.8900 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 5.821156 $125.4400 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 2.000000 $16.5200 $8.2600
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 2.000000 $41.3600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.343379 $15.4500 $45.0000
EXIT -EXIT EXIT ASSESSMENT 136 136 272.000000 $13600.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 16 18.527397 $1389.5600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.066667 $155.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 5.005480 $375.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 10 11 11.021918 $826.6400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 16 16 19.584475 $1086.9400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 209 210 338.255380 $25369.1600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 39 39 85.285714 $6396.4300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 42 42 67.714286 $5078.5700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 273 276 481.892756 $26745.0600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 91 92 156.002740 $11700.2000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 9.000000 $459.4500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 1.246576 $63.6300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 6 7.054795 $360.1500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 4.541248 $231.8300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 1.295890 $66.1600 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 2.654489 $39.8200 $15.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 11 13 57.711111 $2946.1600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 2.200000 $112.3100 $51.0500
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Subtotal (Total Children Is Unduplicated) 547 949 1606.996592 $99731.2600 $62.0600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 36 40.768820 $203844.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 32 33 31.004989 $1550.2500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 10.036508 $718.7100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 4.121156 $947.8500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 203 226 255.666912 $12783.3300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 2.500000 $62.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 144 205 446.640040 $22332.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 50.280953 $1257.0300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 31 38 80.185715 $4009.3000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 88 103 194.169852 $9708.5500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 3.900000 $97.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 100 129 236.867465 $11843.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 20.676191 $516.9100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 3.714286 $92.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1218 1542 12382.753737 $619138.1400 $50.0000
INTR -T1013 INTERPRETER 124 167 650.966664 $32548.3500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1371 2335 16479.070970 $164790.8200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 36 42 295.141268 $21084.9100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 20.714286 $1184.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 119 161 1114.634924 $79629.5700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 27.539683 $1574.1600 $57.1600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 2.577777 $293.8600 $114.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 3 3 2.888888 $52.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 147 188 1559.347623 $111399.8100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 7.571429 $433.0800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 58.642858 $813.9600 $13.8800
TRAV -TRAVS Travel by mile 1415 2557 28060.996807 $12487.1600 $0.4500
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Subtotal (Total Children Is Unduplicated) 1441 7798 62044.379801 $1315651.4000 $21.2100
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Total 8824 63795.844647 $1415418.0200 $22.1900
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Number of Children (Unduplicated) With at Least One Authorization 1501