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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2709 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 136 154 116.194751 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 136 154 116.194751 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 38 56 37.426789 $1815.2100 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 16.714286 $465.1600 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 8 2.126027 $244.4900 $115.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 51 61 32.367735 $1652.3900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 76 101 62.081322 $3169.2500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 68 88 50.446043 $2575.2800 $51.0500
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Subtotal (Total Children Is Unduplicated) 192 320 201.162202 $9921.7700 $49.3200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 37 46 33.181885 $165909.0000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.087671 $250.1700 $230.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 355 449 776.257127 $38812.7900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 171 227 322.673011 $16133.6300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 135 180 283.380959 $14169.0800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 337 444 570.600794 $28530.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 457 599 3750.939652 $187547.1100 $50.0000
INTR -T1013 INTERPRETER 1 1 9.000000 $450.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 55 69 466.730156 $33343.1700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 79 112 721.595234 $51550.8300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 9.600000 $548.7400 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 10 11 2.745205 $625.9100 $228.0000
SENS -V5264 EARMOLD 9 10 2.526027 $45.4700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 66 83 480.187294 $34304.6200 $71.4400
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Subtotal (Total Children Is Unduplicated) 629 2235 7430.505015 $572220.5300 $77.0100
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Total 2709 7747.861968 $582142.3000 $75.1400
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Number of Children (Unduplicated) With at Least One Authorization 746