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 3592 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 4 4 12.427778 $459.8300 $37.0000
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Subtotal (Total Children Is Unduplicated) 18 20 89.103969 $459.8300 $5.1600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 12 13 11.983334 $581.1900 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.755556 $41.6100 $23.7000
EXIT -EXIT EXIT ASSESSMENT 6 6 46.866667 $2343.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 18 18 14.811110 $1110.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 31 31 25.091268 $1881.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 16 16 12.272221 $920.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 27 27 23.877777 $1325.2100 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $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
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Subtotal (Total Children Is Unduplicated) 72 118 144.857933 $8691.6600 $60.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.933333 $96.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.833333 $41.6700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 3 2.505555 $576.2700 $229.9900
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 5 8 17.633333 $1292.8700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 7 30.317459 $757.9400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 49 59 548.898414 $27444.9300 $50.0000
INTR -T1013 INTERPRETER 3 5 34.666667 $1733.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1139 2683 23053.860298 $230538.5800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 21.342857 $1524.7400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 19.857143 $1135.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1 1 6.400000 $457.2200 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 3 2.027777 $131.8000 $65.0000
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Subtotal (Total Children Is Unduplicated) 1142 3454 25124.765054 $349577.3600 $13.9100
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Total 3592 25358.726956 $358728.8500 $14.1500
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Number of Children (Unduplicated) With at Least One Authorization 1149