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: 04-01-18 and 06-30-18 Date of Report: 08-10-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1626 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 6 11.800001 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 6 11.800001 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 2.000000 $97.0000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.405556 $8.7400 $21.5500
EXIT -EXIT EXIT ASSESSMENT 4 4 141.611111 $7080.5600 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 2.205557 $165.4300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 15 15 17.600002 $1320.0200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.022222 $1.6700 $74.9300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 11 2.500001 $187.5100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 17 17 8.066667 $447.7000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.100000 $7.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.516667 $263.7500 $75.0000
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Subtotal (Total Children Is Unduplicated) 32 61 180.027783 $9690.8600 $53.8300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 3.033333 $151.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 24 15.738889 $786.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 171 258 319.476192 $15973.8200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 0.877778 $21.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 13 13 3.050001 $152.5100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 8 4.355556 $217.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 6.361111 $318.0600 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 2 3.200000 $234.6200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 2.400000 $60.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 20 22 92.742858 $4637.1500 $50.0000
INTR -T1013 INTERPRETER 3 3 18.199999 $910.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 670 1211 5533.362715 $55333.6400 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.505556 $32.8600 $65.0100
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Subtotal (Total Children Is Unduplicated) 670 1559 6006.303988 $88855.9800 $14.7900
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Total 1626 6198.131772 $98546.8400 $15.9000
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Number of Children (Unduplicated) With at Least One Authorization 670