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 1474 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 3 3 3.861112 $142.8600 $37.0000
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Subtotal (Total Children Is Unduplicated) 7 7 23.884922 $142.8600 $5.9800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 5 5.000000 $242.5000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.383333 $9.0800 $23.7000
EXIT -EXIT EXIT ASSESSMENT 1 1 0.288889 $14.4500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 2.766667 $207.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 13 6.233334 $467.5100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 7 3.416667 $256.2500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 11 11 5.350000 $296.9200 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 28 47 27.438890 $1705.2100 $62.1500
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.922222 $46.1100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 2 1.350000 $310.5000 $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 3 3 4.233333 $310.3900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 7.142858 $178.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 18 20 109.842857 $5492.1400 $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 2 2 15.276190 $1091.3300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 12.857143 $735.4300 $57.2000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.500000 $32.5000 $65.0000
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Subtotal (Total Children Is Unduplicated) 678 1420 5943.292869 $79728.9900 $13.4100
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Total 1474 5994.616681 $81577.0700 $13.6100
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Number of Children (Unduplicated) With at Least One Authorization 680