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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 12272 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 3 3 2.844444 $105.2400 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 105 117 444.989204 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1360 1643 53397.054930 $1975690.7600 $37.0000
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Subtotal (Total Children Is Unduplicated) 1381 1763 53844.888578 $1975796.0000 $36.6900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 43 51 36.578690 $1774.0700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.688889 $95.4100 $56.4900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.450000 $4.4800 $9.9600
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 4.000000 $153.8800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 20 22 20.705555 $1756.6500 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 10 10 7.955556 $406.2900 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.411111 $9.2100 $22.4000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 160 162 321.750000 $16087.5000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 21.000000 $1575.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 28 41 78.500000 $5887.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 10 19.500000 $1082.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 144 144 263.500000 $19762.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 20 20 33.500000 $2512.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 27 27 46.000000 $3450.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 353 361 670.642857 $37220.6800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 255 298 564.642857 $42348.2200 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 6.147945 $313.8500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 18.285714 $933.4900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.147945 $109.6500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 10 12.000000 $612.6000 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 8 9 10.000000 $510.5000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 11 12 23.230528 $1185.9200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 4.000000 $195.7600 $48.9400
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Subtotal (Total Children Is Unduplicated) 702 1229 2177.637647 $138668.1600 $63.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 35 39 41.384777 $206923.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 2 0.488889 $24.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 12 13 16.807936 $840.4000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.450000 $32.2200 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.983333 $142.0200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 34 34 39.366666 $9054.3200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 238 256 400.874034 $20043.7100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 33.352381 $833.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 188 243 510.039687 $25502.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 3.866666 $96.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 67 76 135.538890 $6776.9500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 111 138 261.299215 $13065.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 92.000000 $2300.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 145 180 330.583336 $16529.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 9.733333 $243.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1451 1841 14051.690415 $702585.1200 $50.0000
INTR -T1013 INTERPRETER 183 201 891.397612 $44569.9200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1607 2744 18185.663433 $181856.7800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 66 82 641.752375 $45846.8300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 7 7 58.571428 $3350.2800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 124 158 1165.279267 $83247.6500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 15 16 89.966667 $5142.4900 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -V5264 EARMOLD 2 2 3.318722 $59.7400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 153 185 1493.951574 $106728.0000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 17 20 177.000000 $2456.7600 $13.8800
TRAV -TRAVS Travel by mile 1634 3022 18561.030102 $8259.6700 $0.4500
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Subtotal (Total Children Is Unduplicated) 1682 9280 57198.390738 $1486510.7900 $25.9900
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Total 12272 113220.916963 $3600974.9500 $31.8000
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Number of Children (Unduplicated) With at Least One Authorization 1774