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 1725 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 69 75 96.398798 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 69 75 96.398798 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 9 9 18.000000 $900.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 9 9 18.000000 $900.0000 $50.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.200000 $10.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 8 12.588891 $629.4600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.331507 $79.3200 $239.2700
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 26 33 273.066664 $13653.3500 $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 16 17 63.873812 $4563.1400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 6 13.035714 $745.6400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 31 40 168.483332 $12036.4500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 13.378571 $764.7200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 0.942466 $61.2700 $65.0100
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.079452 $18.8500 $237.2600
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 1 1 0.128767 $61.0800 $474.3600
SENS -V5264 EARMOLD 2 3 1.666666 $30.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 26 30 134.857144 $9634.2000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 76.785714 $1065.7900 $13.8800
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Subtotal (Total Children Is Unduplicated) 782 1641 9696.423274 $157692.5500 $16.2600
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Total 1725 9810.822072 $158592.5500 $16.1700
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Number of Children (Unduplicated) With at Least One Authorization 837