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: 01-01-19 and 03-31-19 Date of Report: 05-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2558 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 1.166667 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 18.857143 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 35 35 37.664287 $1393.5800 $37.0000
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Subtotal (Total Children Is Unduplicated) 39 39 57.688097 $1393.5800 $24.1600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 6 6.000000 $291.0000 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 20 24 7.377779 $102.3300 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 32 33 17.422223 $412.9100 $23.7000
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.511111 $8.5400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 11.857143 $265.6000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.588889 $26.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.588889 $67.7200 $115.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 0.288889 $14.4500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 14 7.833333 $587.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 16 28 18.011111 $1350.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 18 13.427779 $1007.0900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 23 21.050000 $1168.2800 $55.5000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 5.500000 $412.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 12.500000 $693.7500 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 90 167 124.957146 $6508.9900 $52.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 10 10.000000 $50000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.922222 $46.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.133333 $9.5500 $71.5900
AUDE -V5160 DISPENSING FEE BINAURAL 24 25 22.327778 $5135.3900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 21 21 18.566666 $928.3300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 70 85 122.629366 $6131.4700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 43 50 51.077778 $2553.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 57 92.766667 $4638.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 40 44 51.527779 $2576.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 0.977778 $24.4500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 12 13 22.316666 $1636.2500 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 15 50.895241 $1272.3800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 613 755 4333.112699 $216655.3500 $50.0000
INTR -T1013 INTERPRETER 1 1 3.200000 $160.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 677 1127 5449.422232 $54494.1600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 45 56 312.875396 $22351.8300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 5 29.661904 $1696.6500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 40 42 310.452386 $22178.7000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 25.980953 $1485.0700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.500000 $32.5000 $65.0000
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 31 32 213.199209 $15230.9500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 3.504762 $48.6500 $13.8800
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Subtotal (Total Children Is Unduplicated) 683 2352 11129.050815 $409379.4100 $36.7800
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Total 2558 11311.696058 $417281.9800 $36.8900
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Number of Children (Unduplicated) With at Least One Authorization 685