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: 07-01-17 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 6597 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 3 3 1.544444 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 11 56.652381 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 14 58.196825 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 7 7.755557 $376.1500 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.677778 $14.4700 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 8 8 3.422222 $43.1500 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 122 133 181.448418 $3910.2300 $21.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 6 4.166666 $187.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 6 4.638888 $533.4600 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.005556 $0.2800 $50.4000
EXIT -EXIT EXIT ASSESSMENT 15 15 152.477777 $7623.8900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 3 2.822222 $211.6700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 43 71 86.075396 $6455.6500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 66 126 175.553973 $13166.5900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 5 4.511111 $338.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 38 61 63.938892 $4795.4400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 85 154 153.472225 $8517.7200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 16 29.883334 $2241.2600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 83 84 390.500000 $21672.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 63 66 131.916667 $9893.7500 $75.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.294444 $15.0300 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.011111 $51.6200 $51.0500
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Subtotal (Total Children Is Unduplicated) 319 766 1396.572237 $80198.9300 $57.4300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 16 13.994445 $69972.5000 $5000.0200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 4 8.377778 $418.8900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 44 49 31.422223 $7227.1300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 107 122 183.161904 $9158.1000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 10 7.655556 $191.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 370 668 1446.802607 $72340.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 18 19 34.517460 $862.9400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 19 17.900000 $895.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 16 29.772223 $1488.6200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 6.466667 $161.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 10 19.005556 $950.2800 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 29 34 114.660316 $8406.8900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 35 38 313.319043 $7832.9700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1085 1964 20192.604776 $1009630.0800 $50.0000
INTR -T1013 INTERPRETER 3 3 26.866666 $1343.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1118 2787 22415.972453 $224159.7000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 26 254.904762 $18210.4100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 5 35.990476 $2058.6500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1 1 11.714286 $836.8700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 6.733333 $384.8800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 3 2.027778 $131.8100 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.944444 $215.3200 $227.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 6.000000 $2736.0000 $456.0000
SENS -V5264 EARMOLD 3 6 8.027777 $144.5000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 11 101.290475 $7236.2000 $71.4400
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Subtotal (Total Children Is Unduplicated) 1123 5817 45290.133004 $1446994.3100 $31.9500
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Total 6597 46744.902066 $1527193.2300 $32.6700
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Number of Children (Unduplicated) With at Least One Authorization 1129