Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2973 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 71 77 102.065465 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 3.555556 $131.5600 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 73 79 105.621021 $131.5600 $1.2500
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 3.000000 $358.8000 $119.6000
EXIT -EXIT EXIT ASSESSMENT 9 9 18.000000 $900.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.252055 $3.9300 $15.6000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 11 12 21.252055 $1262.7300 $59.4200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 6 3.755555 $187.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 26 29 41.153970 $2057.7100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 3.095891 $740.5900 $239.2200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 130 141 31.640810 $1582.1800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 15 16 0.537503 $13.4500 $25.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 35 39 62.066666 $3103.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 11 11.333332 $283.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 11 16.716665 $835.8300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 9.266666 $231.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 21 25 36.133333 $1806.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 7 7.633333 $190.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 24 29 40.248174 $2012.4100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 8 9.933332 $248.3300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 78 96 2995.714289 $74892.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 558 712 5443.527775 $272176.5200 $50.0000
INTR -T1013 INTERPRETER 35 40 298.157140 $14907.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 757 1151 8412.337620 $84123.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 83 115 495.238099 $35379.8200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 13 17 80.007143 $4576.4200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 113 149 592.545238 $42331.3600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 30 33 142.453570 $8142.6500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 9 1.791782 $116.4900 $65.0100
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.252055 $29.8900 $118.5800
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 4.000000 $948.4800 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
2 2 0.331507 $78.6300 $237.1900
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 7 7 2.016439 $956.3500 $474.2800
SENS -V5264 EARMOLD 26 31 41.753965 $751.5700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 126 172 817.483338 $58401.0000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 6 8 81.142857 $1126.2700 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 855 2882 19683.268047 $617233.6400 $31.3600
-------------------------------------------------------------------------------------------------------------------------------------
Total 2973 19810.141123 $618627.9300 $31.2300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 911