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 6193 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 61 72 141.390475 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 61 72 141.390475 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 38 43 43.690162 $2118.9800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $51.3500 $51.3500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.266667 $12.0000 $45.0100
EXIT -EXIT EXIT ASSESSMENT 136 136 272.000000 $13600.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 3.000000 $225.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 1.500000 $112.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 15.000000 $832.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 8.000000 $600.0000 $75.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.533333 $8.0000 $15.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 175 204 355.995641 $18322.7900 $51.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 28 29 26.554196 $1327.7100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 202 225 254.666912 $12733.3300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 2.500000 $62.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 144 202 440.282897 $22014.2000 $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 87 101 191.403185 $9570.2100 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 62 68 576.771428 $28838.6200 $50.0000
INTR -T1013 INTERPRETER 123 165 647.252378 $32362.6400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1371 2334 16477.870970 $164778.8200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 57.571428 $4112.9200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 12 12 87.492064 $6250.4400 $71.4400
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.533333 $60.8000 $113.9900
SENS -V5264 EARMOLD 1 1 0.533333 $9.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 36 343.142856 $24514.1600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.142857 $182.4200 $13.8800
TRAV -TRAVS Travel by mile 1415 2556 28059.796807 $12486.6200 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1434 5917 47573.424968 $347029.1000 $7.2900
-------------------------------------------------------------------------------------------------------------------------------------
Total 6193 48070.811084 $365351.8900 $7.6000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1465