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: 07-01-18 and 09-30-18 Date of Report: 11-06-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2631 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 1.000000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 4 8.533333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 5 9.533333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 2.388889 $115.8600 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 17 17 6.005556 $83.3000 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 40 43 19.516663 $462.5400 $23.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 1.161111 $52.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 1.161111 $133.5300 $115.0000
EXIT -EXIT EXIT ASSESSMENT 2 2 41.000000 $2050.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 19 32 21.955555 $1646.6600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 25 45 33.001585 $2475.1000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 2 0.283333 $21.2500 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 15 24 19.877777 $1490.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 23 41 41.699999 $2314.3400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 2.650000 $198.7500 $75.0000
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Subtotal (Total Children Is Unduplicated) 95 219 190.701579 $11044.4000 $57.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 9 7.866667 $39333.5000 $5000.0200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.833333 $41.6700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 1.277777 $91.5000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 16 16 13.283332 $3055.1400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 21 23 13.588096 $679.4100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 152 214 270.489679 $13524.4700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 2.627777 $65.6900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 34 34 25.516664 $1275.8200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 20 24 29.212696 $1460.6300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 22 24 19.638889 $981.9500 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 15 20 30.566665 $2241.1400 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 16 18 47.346033 $1183.6400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 666 846 5163.840447 $258192.0700 $50.0000
INTR -T1013 INTERPRETER 3 5 17.966666 $898.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 679 1142 5580.377740 $55803.7800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 12 54.119048 $3866.2700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 16.809524 $961.5100 $57.2000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.511111 $33.2200 $65.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.833333 $379.9800 $455.9800
SENS -V5264 EARMOLD 2 2 1.161111 $20.9000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 6 45.561905 $3254.9600 $71.4400
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Subtotal (Total Children Is Unduplicated) 683 2407 11343.428493 $387345.5500 $34.1500
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Total 2631 11543.663405 $398389.9500 $34.5100
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Number of Children (Unduplicated) With at Least One Authorization 684