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: 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 3399 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 64 72 80.349211 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 64 72 80.349211 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 4.066667 $467.6700 $115.0000
EXIT -EXIT EXIT ASSESSMENT 60 60 120.000000 $6000.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.855556 $12.8300 $15.0000
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Subtotal (Total Children Is Unduplicated) 63 63 124.922223 $6480.5000 $51.8800
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 8 9.566667 $478.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 17 24 28.688892 $1434.4600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.400000 $782.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 125 132 38.528624 $1926.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 1.512501 $37.8200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 14 29.707141 $1485.3500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 16 19 19.083334 $477.0900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 9 18.723809 $936.1900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 9 10.516667 $262.9200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 7 18.178572 $908.9300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.100000 $2.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 12 12 21.365474 $1068.2600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 6.900001 $172.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 86 106 3464.428584 $86610.7000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 841 1077 8421.428517 $421072.0300 $50.0000
INTR -T1013 INTERPRETER 20 24 245.790475 $12289.5200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 965 1369 10538.595965 $105386.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 81 108 448.542861 $32043.8900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 17 22 114.454763 $6546.8200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 80 109 451.252381 $32237.4900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 11 36.628572 $2093.6900 $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 3 3 3.800000 $1732.8000 $456.0000
SENS -V5264 EARMOLD 18 24 23.433335 $421.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 123 153 622.107153 $44443.3100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 4 5.500000 $76.3400 $13.8800
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Subtotal (Total Children Is Unduplicated) 1093 3264 24585.234288 $755448.3600 $30.7300
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Total 3399 24790.505722 $761928.8700 $30.7300
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Number of Children (Unduplicated) With at Least One Authorization 1136