Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3201 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 29 34 22.727775 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 29 34 22.727775 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 50 90 47.006168 $2279.8200 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 2.477778 $62.7100 $25.3100
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 8 9.015527 $1036.7800 $115.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 4 3.266667 $166.7700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 51 68 40.402513 $2062.5500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 12 2.750000 $140.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 55 73 47.366743 $2418.0700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 9.428571 $481.3300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 112 139 91.350425 $4663.4400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 1.504110 $76.7800 $51.0500
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Subtotal (Total Children Is Unduplicated) 232 402 255.912946 $13457.2700 $52.5900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 47 65 41.413776 $207069.5000 $5000.0100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 392 558 1381.757148 $69087.8600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 204 277 655.544444 $32777.2300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 179 262 549.983336 $27499.1600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 418 569 1163.019867 $58151.1100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 438 607 3824.415881 $191220.8600 $50.0000
INTR -T1013 INTERPRETER 29 39 285.869845 $14293.5100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 79 632.857145 $45211.2900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 16.209524 $927.1900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 74 120 800.628570 $57196.9300 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 8 8 9.015527 $2055.5300 $228.0000
SENS -V5264 EARMOLD 10 11 10.706241 $192.7100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 127 164 1197.617464 $85557.8300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 25.428571 $352.9500 $13.8800
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Subtotal (Total Children Is Unduplicated) 638 2765 10595.467339 $791823.6400 $74.7300
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Total 3201 10874.108060 $805280.9200 $74.0500
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Number of Children (Unduplicated) With at Least One Authorization 677