Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2360 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 12 16 21.155556 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 12 16 21.155556 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.183333 $8.2500 $44.9900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.183333 $21.0800 $114.9800
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 21 27 90.984917 $4549.2600 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 24 31 93.351583 $4680.6800 $50.1400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 135 162 128.072417 $6403.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 58 62 29.522695 $738.0700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 78 82 150.149863 $7507.5000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.500000 $37.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 33 35 106.507141 $5325.3600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 57 59 133.896552 $6694.8300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 71 76 160.561899 $8028.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.000000 $50.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 4 10.142857 $253.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 923 1178 8647.533355 $432376.3600 $50.0000
INTR -T1013 INTERPRETER 2 2 11.428571 $571.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 106 135 1140.938105 $81508.5100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.285714 $302.3400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 141 195 1541.095959 $110095.8300 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.183333 $41.7900 $227.9600
SENS -V5264 EARMOLD 1 1 0.183333 $3.3000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 232 317 2433.142859 $173823.6100 $71.4400
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Subtotal (Total Children Is Unduplicated) 1154 2313 14502.144653 $833761.7600 $57.4900
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Total 2360 14616.651792 $838442.4400 $57.3600
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Number of Children (Unduplicated) With at Least One Authorization 1161