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: 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 1417 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 3 1.288889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 3 1.288889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 435 445 464.422222 $10909.2800 $23.4900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.0000 $115.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.122222 $6.2400 $51.0400
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 8.428571 $412.5000 $48.9400
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Subtotal (Total Children Is Unduplicated) 440 452 476.973015 $11596.1600 $24.3100
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $690.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 318 371 396.506334 $19825.2500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 18 21 14.711111 $735.5600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 108 116 149.950790 $7497.5300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 139 156 112.809514 $5640.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 94 106 837.565073 $41878.2800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 17.142857 $171.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 14 60.023812 $4288.0900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 21 23 119.071430 $6810.8800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 75 84 458.732544 $32771.8400 $71.4400
SENS -V5264 EARMOLD 5 5 5.000000 $90.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 48 55 365.195640 $26089.5700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 66.780952 $926.9200 $13.8800
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Subtotal (Total Children Is Unduplicated) 529 962 2606.490057 $147415.7600 $56.5600
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Total 1417 3084.751961 $159011.9200 $51.5500
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Number of Children (Unduplicated) With at Least One Authorization 868