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: 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 1368 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 2 2 1.766666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.766666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 227 232 232.044444 $5450.7200 $23.4900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 16.620635 $813.4200 $48.9400
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Subtotal (Total Children Is Unduplicated) 236 243 254.665079 $6570.4400 $25.8000
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 5.000000 $1150.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 351 417 386.336481 $19316.7000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 21 21 19.955555 $997.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 127 142 104.374588 $5218.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 154 171 136.812690 $6840.5900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 98 113 1055.896819 $52794.8900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 29 32 187.926986 $13425.4900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 26 27 174.315877 $9970.8500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 91 112 594.859541 $42496.7100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 4.928571 $281.7200 $57.1600
SENS -V5264 EARMOLD 3 3 2.566667 $46.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 64 79 539.925400 $38572.2600 $71.4400
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Subtotal (Total Children Is Unduplicated) 589 1123 3212.899175 $191111.8400 $59.4800
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Total 1368 3469.330920 $197682.2800 $56.9800
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Number of Children (Unduplicated) With at Least One Authorization 758