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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3013 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 128 134 121.607928 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 128 134 121.607928 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 42 55 37.310805 $1809.5700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 8 10.142857 $282.2800 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 9 3.460276 $397.9200 $115.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 47 57 34.090944 $1740.3500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 80 107 59.348926 $3029.7700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 63 84 45.955252 $2346.0200 $51.0500
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Subtotal (Total Children Is Unduplicated) 196 321 191.309060 $9656.9600 $50.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 41 55 38.273211 $191366.5000 $5000.0100
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.504110 $345.9400 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 406 563 920.857924 $46042.8400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 183 243 320.004759 $16000.2200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 173 241 387.251591 $19362.6000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 376 513 710.133318 $35506.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 449 632 3710.965062 $185548.4600 $50.0000
INTR -T1013 INTERPRETER 2 2 5.314286 $265.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 51 64 426.519049 $30470.5700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 90 132 830.625393 $59339.9700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 8.866667 $506.8200 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 10 11 4.060276 $925.7300 $228.0000
SENS -V5264 EARMOLD 9 10 3.964386 $71.3600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 64 88 494.152384 $35302.2300 $71.4400
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Subtotal (Total Children Is Unduplicated) 623 2558 7862.492416 $621055.5200 $78.9900
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Total 3013 8175.409404 $630712.4700 $77.1500
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Number of Children (Unduplicated) With at Least One Authorization 729