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 3945 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 -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.116667 $24.0600 $21.5500
EXIT -EXIT EXIT ASSESSMENT 15 15 152.477777 $7623.8900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 1.033333 $77.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 28 28 15.661112 $1174.5900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 55 56 52.769846 $3957.7700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 1.911111 $143.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 28 28 16.216670 $1216.2800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 65 67 43.150004 $2394.8500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.627778 $47.0900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 3.000000 $166.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.916667 $293.7500 $75.0000
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Subtotal (Total Children Is Unduplicated) 111 213 299.636522 $17495.7500 $58.3900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.116667 $15583.5000 $5000.0500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 4 8.377778 $418.8900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.811111 $186.5500 $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 370 666 1435.935940 $71796.8600 $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 4 5 22.450793 $1646.0900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 12.844444 $321.1100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 39 45 241.745238 $12087.2800 $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
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 3 2.027778 $131.8100 $65.0000
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Subtotal (Total Children Is Unduplicated) 1118 3718 24468.628234 $341383.1100 $13.9500
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Total 3945 24826.461581 $358878.8600 $14.4600
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Number of Children (Unduplicated) With at Least One Authorization 1124