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: 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 3592 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 84 89 139.088888 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 84 89 139.088888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 3.333333 $383.3300 $115.0000
EXIT -EXIT EXIT ASSESSMENT 61 63 135.571429 $6778.5700 $50.0000
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Subtotal (Total Children Is Unduplicated) 63 65 138.904762 $7161.9000 $51.5600
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 6 7.077778 $353.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 22 31.755558 $1587.7900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 8.066667 $1855.3400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 146 153 52.031593 $2601.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 8 8 2.016668 $50.4200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 17 19 22.650002 $1132.5100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 13 15 19.800000 $495.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 10 16.561113 $828.0700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 7 12.633333 $315.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 6 5.577778 $278.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.533333 $38.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 13 16 17.127780 $856.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 10 10.050000 $251.2500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 100 140 2558.571443 $63964.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 879 1150 8233.100011 $411655.4600 $50.0000
INTR -T1013 INTERPRETER 24 30 215.142857 $10757.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1005 1425 10248.891290 $102489.0300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 96 121 478.955955 $34216.6100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 23 26 99.860714 $5712.0300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 70 84 394.426202 $28177.7600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 5 20.047620 $1145.9200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 7 10.666667 $4864.0200 $456.0000
SENS -V5264 EARMOLD 18 21 27.644445 $497.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 114 142 647.428585 $46252.2100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 9.857143 $136.8200 $13.8800
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Subtotal (Total Children Is Unduplicated) 1106 3438 23154.474535 $721035.2400 $31.1400
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Total 3592 23432.468185 $728197.1400 $31.0800
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Number of Children (Unduplicated) With at Least One Authorization 1168