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: 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 2696 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 1 1 0.511111 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 13.814286 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 14.325397 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 5 3.266666 $158.4300 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.166667 $3.5600 $21.3500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 55 57 48.546031 $1046.1600 $21.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.511111 $23.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.511111 $58.7800 $115.0000
EXIT -EXIT EXIT ASSESSMENT 2 2 2.266667 $113.3400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 1.150000 $86.2500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 26 14.055555 $1054.1600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 29 52 23.366663 $1752.4700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 2 0.916667 $68.7500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 19 31 19.833332 $1487.4900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 39 73 45.622222 $2532.0300 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 26 26 92.000000 $5106.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 21 22 40.083334 $3006.2600 $75.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.188889 $9.6400 $51.0500
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Subtotal (Total Children Is Unduplicated) 132 304 292.484915 $16506.3200 $56.4300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 3.355556 $16778.0000 $5000.0700
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 25 26 11.238888 $2584.9200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 34 36 42.357142 $2117.8600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 4.505556 $112.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 184 261 356.239660 $17811.9900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 10 14.573810 $364.3500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 6 7.311111 $365.5600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 6 12.266667 $613.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.066667 $76.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 1.533333 $76.6700 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 10 15.790477 $1157.7600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 15 69.303175 $1732.5800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 650 838 4798.413476 $239920.6300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 675 1140 5418.577733 $54185.7600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 12 95.066666 $6791.5600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 16.419047 $939.1700 $57.2000
PHY -97110HM PT SESSION BY PT ASST 1 1 2.800000 $160.0500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.511111 $33.2200 $65.0000
SENS -V5264 EARMOLD 1 2 0.644445 $11.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 6 29.476191 $2105.7900 $71.4400
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Subtotal (Total Children Is Unduplicated) 684 2388 10904.450711 $347990.0800 $31.9100
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Total 2696 11211.261023 $364496.4000 $32.5100
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Number of Children (Unduplicated) With at Least One Authorization 685