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 141 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 9 12 10.642857 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 9 12 10.642857 $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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1 2 0.366666 $29.3300 $79.9900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 39 48 27.167843 $1358.4100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 12 12 3.102434 $77.5700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 9 1.380820 $69.0300 $49.9900
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 7 1.325265 $66.2600 $49.9900
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 0.255555 $12.7800 $49.9900
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6 8 53.000000 $2650.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 7 25.928572 $1852.3300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 11 13 94.028571 $6717.4000 $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 17 18 117.285713 $8378.8900 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 75 127 323.841439 $21227.7500 $65.5500
-------------------------------------------------------------------------------------------------------------------------------------
Total 141 334.850962 $21257.0800 $63.4800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 81