Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 1603 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 50 52 62.598410 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 50 52 62.598410 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.504110 $60.3000 $119.6200
EVAL -96111 DEVELOPMENTAL EVALUATION 8 10 2.451063 $122.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 11 11 1.593149 $79.6600 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 2.010958 $150.8300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 3 3 0.544445 $27.8000 $51.0600
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 8 8 0.743228 $37.9500 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 4 4 6.804154 $347.3500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 7 0.510731 $26.0800 $51.0700
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.084932 $4.3300 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 0.750001 $38.2900 $51.0600
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 0.076985 $3.9300 $51.0600
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Subtotal (Total Children Is Unduplicated) 49 58 18.084714 $1049.7900 $58.0500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 0.745206 $3726.0000 $4999.9600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 20 25 13.311340 $665.5800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 17 24 29.644446 $741.1200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 178 232 273.204768 $13660.2700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 199 262 820.723018 $20518.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 70 116 113.388887 $5669.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 45 65 110.463491 $2761.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 32 52 45.600003 $2280.0200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 21 27 57.508727 $1437.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 135 169 197.692861 $9884.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 173 236 741.116671 $18527.9600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 3 26.285714 $657.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 47 54 377.321427 $18866.0800 $50.0000
INTR -T1013 INTERPRETER 4 4 25.857143 $1292.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 34 40 290.857143 $20778.8200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 19 23 167.964284 $9607.5700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 32 37 284.339683 $20313.2200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 10 13 87.642858 $5009.6700 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 0.504110 $119.5600 $237.1600
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.252055 $59.7800 $237.1600
SENS -V5264 EARMOLD 2 3 4.088888 $73.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 78 98 696.530947 $49760.2400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.285714 $73.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 2.142857 $29.7400 $13.8800
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Subtotal (Total Children Is Unduplicated) 405 1493 4368.472241 $206514.2400 $47.2700
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Total 1603 4449.155365 $207564.0200 $46.6500
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Number of Children (Unduplicated) With at Least One Authorization 453