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 1589 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 -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.461111 $10.9300 $23.7000
EXIT -EXIT EXIT ASSESSMENT 2 2 41.000000 $2050.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 14 14 6.938889 $520.4200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 20 20 8.769047 $657.6800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.094444 $7.0800 $74.9700
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 12 12 6.577777 $493.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 20 20 13.644443 $757.2600 $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) 42 75 82.524600 $4811.3000 $58.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.833333 $41.6700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.644444 $148.2100 $229.9800
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 2 2 3.266667 $239.5100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 4.444444 $111.1100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 26 28 215.636508 $10781.8300 $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
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.511111 $33.2200 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $938.9300 $71.4400
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Subtotal (Total Children Is Unduplicated) 680 1509 6199.897571 $96984.5500 $15.6400
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Total 1589 6291.955504 $101795.8400 $16.1800
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Number of Children (Unduplicated) With at Least One Authorization 684