Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 2814 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 28 31 21.822219 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 28 31 21.822219 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 87 88 60.949999 $1170.2400 $19.2000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $46.8000 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $119.6000 $119.6000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 12 12 9.622222 $491.2100 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 3 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 14 11.544444 $589.3400 $51.0500
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Subtotal (Total Children Is Unduplicated) 112 119 87.116665 $2570.3400 $29.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.266667 $1333.5000 $5000.6200
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.900000 $215.2800 $239.2000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 855 1140 621.002351 $31049.9700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 136 162 126.283327 $6314.1400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 238 288 232.408310 $11620.3000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 574 709 525.647591 $26282.2500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 89 126 952.385716 $47619.3400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 44 51 292.571429 $20901.3000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 70 83 491.926193 $35143.2000 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $237.1200 $237.1200
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 82 101 640.785714 $45777.7300 $71.4400
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Subtotal (Total Children Is Unduplicated) 1004 2664 3886.177298 $226512.1200 $58.2900
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Total 2814 3995.116182 $229082.4600 $57.3400
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Number of Children (Unduplicated) With at Least One Authorization 1054