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: 07-01-19 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 2535 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 3 3 0.866666 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 6.733333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 31 31 59.179365 $2189.6300 $37.0000
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Subtotal (Total Children Is Unduplicated) 36 36 66.779364 $2189.6300 $32.7900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 2.711719 $131.5200 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 17 17 6.011111 $83.3700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 34 35 14.588889 $345.7600 $23.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.805556 $36.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.805556 $92.6400 $115.0100
EXIT -EXIT EXIT ASSESSMENT 2 2 2.750000 $137.5000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 3.522222 $264.1700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 1.855555 $139.1600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 2.177778 $163.3400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.511111 $28.3700 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 5.833332 $291.6600 $50.0000
SCREEN-T1023 SCREENING 1 1 3.857143 $192.8600 $50.0000
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Subtotal (Total Children Is Unduplicated) 68 78 47.429972 $2017.5900 $42.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 6.000000 $30000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.088889 $4.4500 $50.0100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 3.000000 $214.8300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 19 19 13.022223 $2995.1300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 26 27.216667 $1360.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 37 41 53.629365 $2681.4700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 52 63 72.594445 $3629.7300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.879365 $46.9800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 67 77 123.580953 $6179.0500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 28 30 41.057142 $2052.8500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 7.555556 $188.8900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 8 12.233333 $896.9500 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 26 37 82.758730 $2068.9700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 573 730 4018.899194 $200945.0600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 696 1176 5513.103317 $55131.0500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 46 63 287.216665 $20518.7800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 7 7 23.600000 $1349.9200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 57 69 450.609519 $32191.5400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 6 19.800000 $1131.7700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.377778 $24.5600 $65.0000
SENS -V5264 EARMOLD 1 1 0.755556 $13.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 45 48 316.160316 $22586.5100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 23.780953 $330.0800 $13.8800
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Subtotal (Total Children Is Unduplicated) 699 2421 11098.919966 $386542.9900 $34.8300
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Total 2535 11213.129302 $390750.2100 $34.8500
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Number of Children (Unduplicated) With at Least One Authorization 704