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: 04-01-19 and 06-30-19 Date of Report: 07-21-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2560 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 5 5 4.419047 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 4 10.680953 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 40 40 98.538884 $3645.9200 $37.0000
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Subtotal (Total Children Is Unduplicated) 49 49 113.638884 $3645.9200 $32.0800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 7 6.227778 $302.0500 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 19 19 7.727783 $107.1900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 32 33 12.083335 $286.3800 $23.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 13.000000 $291.2000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.505555 $22.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.505555 $58.1300 $114.9900
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 8 9.033333 $677.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 12 11.027777 $827.0800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 8 2.783334 $208.7600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 7 3.483334 $193.3300 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.516667 $75.8400 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 74 105 75.894451 $3484.2400 $45.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 13 11.566667 $57833.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.011111 $50.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 24 25 14.488890 $3332.4700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 20 22 16.246826 $812.3500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 44 61 74.375398 $3718.7800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 37 40 66.988890 $3349.4500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 53 60 105.205556 $5260.2800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 32 38 42.700000 $2135.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.944445 $98.6100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 14 16 28.311111 $2075.7700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 15 17 57.041272 $1426.0300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 581 746 4176.847639 $208842.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 703 1155 5585.361925 $55853.6300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 54 58 320.311902 $22883.0800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 5 12.161904 $695.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 59 72 455.057145 $32509.2900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 4 24.923810 $1424.6400 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.505555 $32.8600 $64.9900
SENS -V5264 EARMOLD 1 2 1.011111 $18.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 54 63 310.219840 $22162.1000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 6.857143 $95.1800 $13.8800
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Subtotal (Total Children Is Unduplicated) 712 2406 11315.138140 $424609.8700 $37.5300
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Total 2560 11504.671475 $431740.0300 $37.5300
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Number of Children (Unduplicated) With at Least One Authorization 716