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 1635 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
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Subtotal (Total Children Is Unduplicated) 5 5 19.876190 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 4.366667 $211.7900 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.405556 $9.6100 $23.7000
EXIT -EXIT EXIT ASSESSMENT 3 3 4.577778 $228.8900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 11 4.266666 $320.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 19 19 6.877777 $515.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 13 7.038889 $527.9200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 18 9.227778 $512.1400 $55.5000
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Subtotal (Total Children Is Unduplicated) 41 70 36.761111 $2326.1700 $63.2800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.511111 $117.5500 $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 3 3 5.900000 $432.5900 $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 23 24 130.428570 $6521.4500 $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 -97530HM OT SESSION BY OT ASST 1 1 1.571429 $89.8800 $57.2000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.511111 $33.2200 $65.0000
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Subtotal (Total Children Is Unduplicated) 720 1560 6410.220619 $96923.7200 $15.1200
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Total 1635 6466.857920 $99249.8900 $15.3500
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Number of Children (Unduplicated) With at Least One Authorization 722