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: 10-01-17 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 7111 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 23 24 15.566665 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 23 24 15.566665 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $17.9200 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 803 848 853.440475 $18220.9500 $21.3500
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 3.000000 $135.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 4.000000 $460.0000 $115.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 40 42 41.533333 $2120.2800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 16 16 15.522222 $792.4100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 53 60 59.833333 $3054.4900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 862 976 980.329363 $24903.1400 $25.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 6.355556 $31778.0000 $5000.0300
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 7.161111 $1647.0500 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1072 1378 1138.791195 $56939.2000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.588889 $14.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 149 167 140.877771 $7043.8600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 266 310 274.683314 $13734.0700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 778 952 705.668208 $35283.1900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.588889 $14.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.011111 $0.2800 $24.9800
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1330 2018 17609.189688 $880459.7300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 256 343 2099.854777 $150013.6300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 6.571429 $375.8800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 356 442 2400.574617 $171496.9900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 7.928571 $453.2000 $57.1600
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 351 472 2962.530966 $211643.1300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 6 32.285713 $448.1300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1674 6111 27394.661805 $1561363.7700 $57.0000
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Total 7111 28390.557833 $1586266.9200 $55.8700
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Number of Children (Unduplicated) With at Least One Authorization 1703