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 7336 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 86 98 405.389681 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 36 40 1472.428578 $54479.8400 $37.0000
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Subtotal (Total Children Is Unduplicated) 123 140 1879.196037 $54530.8200 $29.0200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 38 48 31.586529 $1531.9500 $48.5000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 0.705556 $36.0400 $51.0700
EXIT -EXIT EXIT ASSESSMENT 206 209 410.750000 $20537.5000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 2 0.907143 $50.3400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 19.500000 $1082.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 9 15.000000 $1125.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 258 289 489.449228 $25029.0600 $51.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 2.000000 $10000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.911111 $45.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 7 14.450793 $722.5400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 5.044444 $1160.2100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 240 263 390.364757 $19518.2500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 8 7.316667 $182.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 178 227 525.576211 $26278.9200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 6.883334 $172.0900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 50 63 131.215875 $6560.8000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 107 126 266.373023 $13318.6900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 48.566667 $1214.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 127 151 279.716675 $13985.8800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 5.000001 $125.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 57 67 523.442856 $26172.1900 $50.0000
INTR -T1013 INTERPRETER 133 168 734.957287 $36747.9000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1552 2768 18143.192457 $181432.1000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 4.466667 $319.1000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 9 32.333333 $2309.8900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 10 77.714285 $5551.9200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.142857 $182.4200 $13.8800
TRAV -TRAVS Travel by mile 1583 3019 18446.157102 $8208.5600 $0.4500
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Subtotal (Total Children Is Unduplicated) 1612 6907 39658.826402 $354209.0800 $8.9300
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Total 7336 42027.471667 $433768.9500 $10.3200
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Number of Children (Unduplicated) With at Least One Authorization 1652