Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-18 and 12-31-18 Date of Report: 02-05-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 9237 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 119 130 290.614283 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.022222 $37.8200 $37.0000
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Subtotal (Total Children Is Unduplicated) 120 131 291.636505 $37.8200 $0.1300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 40 46 29.768037 $1443.7600 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 2.044444 $28.3600 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 8 7.155554 $169.5800 $23.7000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.266667 $10.2600 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.016667 $1.4200 $85.0100
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 8 8 5.322222 $271.8000 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $22.4000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.488889 $112.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.000000 $230.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 157 161 319.500000 $15975.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 3.133334 $235.0100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 10 9.200000 $690.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 8 6.683334 $370.9300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 88 88 150.505479 $11287.9100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 11.000000 $825.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 3.500000 $262.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 295 295 469.505479 $26057.5600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 298 351 536.642857 $40248.2200 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 6.000000 $306.3000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 3.000000 $153.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 6 4.763166 $243.1600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 596 1013 1578.496129 $99199.5600 $62.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 30 33 55.589117 $277946.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.855556 $92.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 20 12.411112 $620.5600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 7.714286 $552.4200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 14 14 19.969840 $4593.0300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 187 201 201.411411 $10070.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 7 12.300000 $307.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 160 213 490.538534 $24526.9900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.600000 $40.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 36 46 101.143656 $5057.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.533333 $63.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 89 108 221.089688 $11054.5100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 126 152 306.829786 $15341.5800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 5.666667 $141.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1332 1645 13191.403194 $659570.8500 $50.0000
INTR -T1013 INTERPRETER 138 158 640.358578 $32017.9700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1480 2434 17040.406870 $170404.2400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 30 44 367.203967 $26233.0800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 26.857143 $1536.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 140 164 1245.920629 $89008.6600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 12 12 105.923809 $6054.6200 $57.1600
RSPT -RSPT RESPITE 1 1 3.571429 $0.0000 $0.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 135 161 1279.628572 $91416.7500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 8 8 64.495238 $895.2000 $13.8800
TRAV -TRAVS Travel by mile 1532 2658 17450.875914 $7765.6600 $0.4500
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Subtotal (Total Children Is Unduplicated) 1562 8093 52857.298329 $1435311.4100 $27.1500
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Total 9237 54727.430963 $1534548.7900 $28.0400
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Number of Children (Unduplicated) With at Least One Authorization 1667