Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 12186 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
CASE -CASE NON-TCM CASE MANAGEMENT 2 2 1.377778 $50.9800 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 98 110 410.645236 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1297 1518 51648.293821 $1910986.2300 $37.0000
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Subtotal (Total Children Is Unduplicated) 1309 1630 52060.316835 $1911037.2100 $36.7100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 40 50 33.586529 $1628.9500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.022222 $57.7400 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 15 15 16.066666 $1363.0900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 16 16 12.316667 $629.0100 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.711111 $11.8800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.022222 $22.9000 $22.4000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.533333 $176.3300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 209 212 416.750000 $20837.5000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 13 23.000000 $1725.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 28 45 58.566666 $4392.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 14 16 23.957143 $1329.6200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 138 139 228.500000 $17137.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 15 15 27.000000 $2025.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 26 26 46.500000 $3487.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 323 332 582.500000 $32328.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 257 322 545.000000 $40875.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 4.000000 $204.2000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 10 5.534245 $282.5300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 6.000000 $306.3000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 8 15.428571 $787.6300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 4.000000 $204.2000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 11 11 8.926418 $455.7000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 8.571429 $419.4800 $48.9400
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Subtotal (Total Children Is Unduplicated) 746 1267 2092.493222 $131987.5100 $63.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 41 33.595661 $167977.5000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 2.422222 $121.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 8 8 15.450793 $772.5400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.766667 $54.9000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 44 46 60.631744 $13945.2700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 246 271 399.507614 $19975.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 8 7.316667 $182.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 181 231 532.442878 $26622.2500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 6.883334 $172.0900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 51 64 134.282542 $6714.1400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 110 130 275.773023 $13788.6900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 48.566667 $1214.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 129 154 286.450009 $14322.5500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 5.000001 $125.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1418 1861 14182.852370 $709143.3500 $50.0000
INTR -T1013 INTERPRETER 157 196 840.804905 $42040.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1553 2770 18149.325790 $181493.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 63 74 616.823813 $44065.9100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 5 41.428571 $2369.7200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 135 173 1213.170125 $86668.9200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 15 16 99.622222 $5694.4100 $57.1600
SENS -V5264 EARMOLD 2 4 3.318721 $59.7400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 149 185 1340.876186 $95792.3000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 14 14 94.428572 $1310.6700 $13.8800
TRAV -TRAVS Travel by mile 1585 3021 18465.299959 $8217.0800 $0.4500
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Subtotal (Total Children Is Unduplicated) 1622 9289 56857.041056 $1442844.3100 $25.3800
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Total 12186 111009.851113 $3485869.0300 $31.4000
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Number of Children (Unduplicated) With at Least One Authorization 1719