Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3572 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 70 77 155.851588 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 70 77 155.851588 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.666667 $30.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 5.118722 $588.6600 $115.0000
EXIT -EXIT EXIT ASSESSMENT 38 38 76.000000 $3800.0000 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 45 46 83.785389 $4518.2100 $53.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 8 8.344445 $417.2300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 24 31 44.100003 $2205.0200 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $690.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 121 130 36.911038 $1845.6900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 8 8 2.207541 $55.1900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 28 34 35.748413 $1787.4300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 11 11.866666 $296.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 13 19.500000 $975.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 2.450000 $61.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 11 18.133333 $906.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.483333 $37.0800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 22 28 31.025397 $1551.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 7 8.033333 $200.8300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 63 85 2297.428575 $57435.7000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 883 1125 8881.638088 $444082.5100 $50.0000
INTR -T1013 INTERPRETER 25 28 215.361903 $10768.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1023 1453 11316.095243 $113161.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 90 123 563.692860 $40270.2400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 18 21 94.409526 $5400.2200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 84 112 503.450003 $35966.4500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.950000 $54.3000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 1.616439 $105.0700 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 4 5 4.333334 $988.0200 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 5.066667 $2310.4200 $456.0000
SENS -V5264 EARMOLD 25 32 31.322223 $563.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 127 164 786.061914 $56156.2200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 2.571429 $35.6900 $13.8800
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Subtotal (Total Children Is Unduplicated) 1109 3449 24929.801706 $783783.1100 $31.4400
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Total 3572 25169.438683 $788301.3300 $31.3200
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Number of Children (Unduplicated) With at Least One Authorization 1167