Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 3327 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 4 5 11.290476 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 3 11.561904 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 8 22.852380 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 71 91 89.520631 $4341.7300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.472222 $83.1600 $56.4900
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.166667 $14.1400 $84.8600
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.044444 $0.9900 $22.3800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.022222 $46.0000 $45.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.511111 $25.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 101 106 168.164558 $8408.2300 $50.0000
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
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Subtotal (Total Children Is Unduplicated) 169 205 261.407411 $12945.1000 $49.5200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 24 36 49.838890 $249195.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.120548 $6.0300 $49.9800
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.044444 $10.2100 $229.7700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 144 161 121.053812 $6052.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 1.172223 $29.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 148 183 255.702378 $12785.1100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 149 181 179.049992 $8952.4600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.200000 $5.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 132 151 173.871420 $8693.5300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 246 283 268.071418 $13403.5300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 3.572222 $89.3100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 18.304762 $1342.1000 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 39 52 367.962698 $18398.1400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 900 2036 8349.464234 $83494.6500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 5 52.753968 $3768.7500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 3 13.422222 $958.8800 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.022222 $10.1200 $455.5500
SENS -V5264 EARMOLD 1 1 0.088889 $1.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 8 39.852380 $2847.0600 $71.4400
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Subtotal (Total Children Is Unduplicated) 900 3114 9894.568722 $410043.4500 $41.4400
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Total 3327 10178.828513 $422988.5500 $41.5600
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Number of Children (Unduplicated) With at Least One Authorization 904