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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 11390 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 4 4 2.533333 $93.7300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 100 115 555.586180 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 982 1012 35965.295235 $1330715.9500 $37.0000
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Subtotal (Total Children Is Unduplicated) 1014 1131 36523.414748 $1330809.6800 $36.4400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 43 52 42.750076 $2073.3700 $48.5000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 4.000000 $153.8800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 19 20 20.322222 $1724.1400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 5 5 5.000000 $255.3500 $51.0700
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 170 172 343.000000 $17150.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 22.000000 $1650.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 18 27 50.000000 $3750.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 13 21 39.000000 $2164.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 100 100 180.500000 $13537.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 16 16 26.500000 $1987.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 16.000000 $1200.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 242 243 438.000000 $24309.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 204 243 435.000000 $32625.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 4.189041 $213.8500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 9 14.000000 $714.7000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.106849 $107.5500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 14 17.000000 $867.8500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 9 10 13.000000 $663.6500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 3 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 19 22 32.895499 $1679.3200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 4.000000 $178.2000 $44.5500
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Subtotal (Total Children Is Unduplicated) 594 1000 1721.263687 $107753.7600 $62.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 33 38 41.404797 $207025.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.505556 $25.2800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 9 9 8.494444 $424.7200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 4.497619 $322.0700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 17 18 23.011111 $5292.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 309 344 428.335892 $21416.8000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 40 46.885922 $1172.1500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 186 247 543.651577 $27182.5300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 5.100000 $127.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 69 84 166.322216 $8316.0800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 103 139 251.045236 $12552.2500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 43.566667 $1089.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 140 181 377.187290 $18859.3100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 8.716667 $217.9200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1306 1770 13276.595248 $663829.7700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 10.104761 $505.2400 $50.0000
INTR -T1013 INTERPRETER 153 203 862.205557 $43110.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1458 2750 17498.525031 $174985.2400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 71 91 696.990479 $49793.0200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 20.266667 $1159.2600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 120 166 1117.931747 $79865.0500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 11 14 70.290478 $4017.8200 $57.1600
SENS -V5264 EARMOLD 3 5 3.927093 $70.6900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 149 193 1535.139682 $109670.3700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 3 10.285714 $734.8100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 17 20 154.152382 $2139.6400 $13.8800
TRAV -TRAVS Travel by mile 1483 2921 17753.744080 $7900.4200 $0.4500
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Subtotal (Total Children Is Unduplicated) 1526 9259 54958.883913 $1441804.9200 $26.2300
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Total 11390 93203.562348 $2880368.3600 $30.9000
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Number of Children (Unduplicated) With at Least One Authorization 1621