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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2455 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 2 2 1.033333 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 16.285714 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 17.319047 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 0.355555 $17.2400 $48.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 0.550000 $6.9400 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 43 47 40.605555 $875.0500 $21.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.155556 $52.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.155556 $132.8900 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.005556 $0.2800 $50.4000
EXIT -EXIT EXIT ASSESSMENT 6 6 4.005555 $200.2800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 14 21 11.161111 $837.0800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 18 30 52.576189 $3943.2100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.588889 $44.1700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 14 22 17.705556 $1327.9200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 28 44 38.133331 $2116.3900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 2 1.500000 $112.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 12 12 24.000000 $1332.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 22.000000 $1650.0000 $75.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.822222 $41.9700 $51.0500
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Subtotal (Total Children Is Unduplicated) 100 209 216.320631 $12689.9100 $58.6600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 6.000000 $30000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 2 2.155555 $107.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 17 18 9.672222 $2224.6100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 21 21 13.322222 $666.1100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.150000 $28.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 159 242 368.730154 $18436.4800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 3.088888 $77.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 1.027778 $51.3900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 5 6.944445 $347.2300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.333333 $8.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 2.977778 $148.8900 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 8 8.966667 $657.4400 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 49.571429 $1239.2800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 600 809 4688.155588 $234407.5400 $50.0000
INTR -T1013 INTERPRETER 1 1 8.266667 $413.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 613 1083 5189.417482 $51894.1200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 12 46.623807 $3330.8000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.133333 $64.8200 $57.2000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.500000 $32.5000 $65.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 2 1.944444 $886.6500 $455.9900
SENS -V5264 EARMOLD 2 3 1.500000 $27.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3 5 26.952380 $1925.4700 $71.4400
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Subtotal (Total Children Is Unduplicated) 617 2242 10438.434172 $346975.7300 $33.2400
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Total 2455 10672.073850 $359665.6400 $33.7000
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Number of Children (Unduplicated) With at Least One Authorization 623