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: 07-01-18 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 6095 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 7 7 6.585714 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 9 70.090477 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 40 40 133.633336 $4944.4400 $37.0000
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Subtotal (Total Children Is Unduplicated) 54 56 210.309527 $4944.4400 $23.5100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 15 13.983334 $678.1900 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 36 40 28.944450 $401.4700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 73 80 65.855549 $1560.7600 $23.7000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.366667 $22.8200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 24.857143 $556.8000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 6 3.277777 $147.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 7 4.288888 $493.2100 $115.0000
EXIT -EXIT EXIT ASSESSMENT 6 6 46.866667 $2343.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 29 46 54.533332 $4089.9900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 43 73 93.101587 $6982.6100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 21 35 43.861109 $3289.5700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 33 57 84.872222 $4710.4100 $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 13 13 22.500000 $1248.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 2.650000 $198.7500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 3.550000 $177.5000 $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) 192 390 502.008725 $27393.0500 $54.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 22 28 26.277779 $131389.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.933333 $96.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.833333 $91.6700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 3.011112 $215.6300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 38 41 51.066666 $11745.3200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 64 76 57.596032 $2879.8000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 210 312 688.460316 $34423.0100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 3.233333 $80.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 80 95 179.261110 $8963.0500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 83 108 297.371426 $14868.5700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 61 77 149.644446 $7482.2300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 4.922222 $123.0600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 28 43 111.650001 $8186.1900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 36 45 198.901583 $4972.5500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1069 1848 19608.759509 $980437.8900 $50.0000
INTR -T1013 INTERPRETER 3 5 34.666667 $1733.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1139 2684 23061.193631 $230611.9100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 88 769.235707 $54954.1800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 10 67.633333 $3868.6200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 63 79 800.880952 $57214.9200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 4 50.704762 $2898.2800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 3 2.027777 $131.8000 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.833333 $1291.9800 $455.9900
SENS -V5264 EARMOLD 3 5 7.194444 $129.5000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 64 77 633.342861 $45246.0000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 8.790476 $122.0100 $13.8800
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Subtotal (Total Children Is Unduplicated) 1148 5649 46824.426144 $1604411.4700 $34.2600
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Total 6095 47536.744396 $1636748.9600 $34.4300
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Number of Children (Unduplicated) With at Least One Authorization 1152