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 7391 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 87 101 501.299203 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 26 26 775.638094 $28698.6200 $37.0000
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Subtotal (Total Children Is Unduplicated) 113 131 1279.470630 $28792.3500 $22.5000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 41 50 40.750076 $1976.3700 $48.5000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 4.000000 $153.8800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
EXIT -EXIT EXIT ASSESSMENT 164 166 331.000000 $16550.0000 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 2 3.000000 $225.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 13 13 24.000000 $1332.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 12 13 25.000000 $1875.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 4.000000 $204.2000 $51.0500
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Subtotal (Total Children Is Unduplicated) 220 254 438.750076 $22827.3400 $52.0300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 2.000000 $10000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 7 7.011111 $350.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 307 342 425.335892 $21266.8000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 40 46.885922 $1172.1500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 185 246 542.968244 $27148.3600 $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 102 138 250.361903 $12518.0800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 43.566667 $1089.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 138 179 374.287290 $18714.3100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 8.716667 $217.9200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 67 82 667.352382 $33367.6200 $50.0000
INTR -T1013 INTERPRETER 150 200 846.205557 $42310.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1456 2747 17469.525031 $174695.2400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 10.085714 $720.5200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 3 10.714286 $765.4300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 5 40.142857 $2867.8100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 2 12.857143 $178.4600 $13.8800
TRAV -TRAVS Travel by mile 1481 2918 17720.744080 $7885.7300 $0.4500
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Subtotal (Total Children Is Unduplicated) 1512 7006 38651.182962 $363942.0200 $9.4200
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Total 7391 40369.403668 $415561.7100 $10.2900
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Number of Children (Unduplicated) With at Least One Authorization 1566