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 1579 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
EXIT -EXIT EXIT ASSESSMENT 2 2 2.266667 $113.3400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.383333 $28.7500 $74.9900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 3.311112 $248.3400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 20 21 5.783333 $433.7500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.305556 $22.9200 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 10 10 3.049999 $228.7400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 30 32 11.361110 $630.5400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.027778 $2.0900 $75.0600
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Subtotal (Total Children Is Unduplicated) 43 83 29.755554 $1866.8800 $62.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.177778 $889.0000 $5000.6200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.300000 $69.0000 $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 184 260 355.239660 $17761.9900 $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 3 3 2.923810 $214.3700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.222222 $5.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16 16 47.623811 $2381.1900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 675 1140 5418.577733 $54185.7600 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.511111 $33.2200 $65.0000
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Subtotal (Total Children Is Unduplicated) 676 1492 5912.190411 $79317.1500 $13.4200
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Total 1579 5956.271362 $81184.0400 $13.6300
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Number of Children (Unduplicated) With at Least One Authorization 679