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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 7112 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 96 110 109.072225 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 5.142857 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 97 111 114.215082 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 50 64 74.850750 $3630.2600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 7 5.246576 $294.3300 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 7.285714 $115.4100 $15.8400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.6700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $14.6800 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.000000 $7.2000 $7.2000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $45.0800 $45.0800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 4.000000 $84.1600 $21.0400
EXIT -EXIT EXIT ASSESSMENT 30 32 41.791194 $2089.5700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 8 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 10 10 20.000000 $1500.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 15 15 29.000000 $1609.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 8 15.000000 $1125.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.033333 $1.7600 $52.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 117 168 242.207567 $13466.8500 $55.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 13 23.856230 $119280.5000 $4999.9700
AUDE -V5160 DISPENSING FEE BINAURAL 2 3 3.000000 $694.8600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 303 343 410.402580 $20520.1300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 11 13 1.538358 $76.9000 $49.9900
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 58 62 93.739530 $2343.4900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 274 349 759.058737 $37952.9700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 25 34 87.966667 $4398.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 14 15 20.988890 $524.7300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 94 111 249.450792 $12472.5300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 11 13 26.452380 $1322.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 8 14.722222 $368.0600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 119 150 319.402383 $15970.1300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 13 17 34.333333 $1716.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 6 6 9.655556 $241.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 178 223 462.601592 $23130.1000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 16 20 41.466665 $2073.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 9 31.366668 $784.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 60 69 562.238097 $28111.8800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 71 84 724.076193 $36203.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 6 49.857143 $2492.8600 $50.0000
INTR -T1013 INTERPRETER 158 212 684.180158 $34209.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1549 2515 18942.463539 $189424.4900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 6 83.657143 $6019.9800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 11 12 87.133334 $6270.1100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 12.857143 $925.2000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 9 60.104761 $4325.1300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 19.428572 $1398.0700 $71.9600
TRAV -TRAVS Travel by mile 1555 2528 18986.734970 $8449.0900 $0.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1625 6833 42802.733636 $561700.4600 $13.1200
-------------------------------------------------------------------------------------------------------------------------------------
Total 7112 43159.156285 $575167.3000 $13.3300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1690