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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2752 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 4 4 18.876190 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 2.033333 $75.2300 $37.0000
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Subtotal (Total Children Is Unduplicated) 6 6 21.909523 $75.2300 $3.4300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 7 6.366667 $308.7900 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 16 16 6.266665 $86.9200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 40 42 21.850000 $517.8400 $23.7000
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.855556 $14.2900 $16.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 1.022222 $46.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 1.022222 $117.5500 $115.0000
EXIT -EXIT EXIT ASSESSMENT 3 3 4.577778 $228.8900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 17 27 16.894442 $1267.0700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 27 45 28.955553 $2171.6500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 17 29 24.538889 $1840.4200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 23 41 35.122222 $1949.2800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.600000 $45.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.600000 $45.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 104 221 152.672216 $8860.6900 $58.0400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 14 11.844445 $59222.5000 $5000.0200
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 1.477777 $105.8200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 25 26 22.466667 $5167.3400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 20 15.311111 $765.5600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 134 182 249.293652 $12464.6900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 0.605556 $15.1400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 40 45 43.244444 $2162.2200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 34 36 66.163491 $3308.1700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 34 37 36.494444 $1824.7200 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 16 17 31.688889 $2323.4300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 13 13 38.190477 $954.7600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 699 894 5403.742835 $270187.1900 $50.0000
INTR -T1013 INTERPRETER 2 2 13.500000 $675.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 719 1201 5840.241256 $58402.4200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 17 18 76.762702 $5483.9500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 9.000000 $514.8000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1 1 2.142857 $153.0900 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.511111 $33.2200 $65.0000
SENS -V5264 EARMOLD 1 2 1.022222 $18.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 23.323809 $1666.2500 $71.4400
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Subtotal (Total Children Is Unduplicated) 722 2525 11887.027745 $425448.6500 $35.7900
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Total 2752 12061.609484 $434384.5700 $36.0100
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Number of Children (Unduplicated) With at Least One Authorization 725