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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2299 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 113 120 86.111217 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 113 120 86.111217 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 38 56 41.130978 $1994.8700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 7.571429 $210.7100 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 5 1.254794 $144.2900 $114.9900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.122222 $6.2400 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 44 54 28.057789 $1432.3700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.322222 $67.5000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 69 90 53.405866 $2726.4000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 67 83 47.278316 $2413.5800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.111111 $4.9500 $44.5500
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Subtotal (Total Children Is Unduplicated) 177 296 180.254727 $9000.9100 $49.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 36 42 29.453046 $147266.0000 $5000.0300
CONIF -CONIF CONSULT, ITDS FACE TO FACE 232 256 383.868252 $19193.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.633333 $40.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 149 196 282.073802 $14103.6500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 110 151 225.100788 $11255.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 270 367 435.988073 $21799.3000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 438 599 3637.222215 $181861.1900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 10.123810 $506.1900 $50.0000
INTR -T1013 INTERPRETER 2 2 9.585714 $479.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 50 60 344.377778 $24602.3500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 74 105 651.071426 $46512.5400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 2.266667 $129.5600 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 4 6 1.753424 $399.7500 $227.9800
SENS -V5264 EARMOLD 4 6 1.753424 $31.5600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 68 88 584.066666 $41725.7400 $71.4400
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Subtotal (Total Children Is Unduplicated) 602 1883 6600.338418 $509906.3600 $77.2500
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Total 2299 6866.704362 $518907.2700 $75.5700
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Number of Children (Unduplicated) With at Least One Authorization 705