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: 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 3556 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 67 73 106.419842 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 67 73 106.419842 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.766667 $203.1700 $115.0000
EXIT -EXIT EXIT ASSESSMENT 63 65 130.000000 $6500.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 1.011111 $15.1700 $15.0000
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Subtotal (Total Children Is Unduplicated) 66 69 132.777778 $6718.3400 $50.6000
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 7 8.555555 $427.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 22 29 28.544443 $1427.2200 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 115 118 33.818007 $1691.0400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 10 5.520835 $138.0300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 15 21 24.542857 $1227.1500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 13 15 15.633334 $390.8400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 11 15.809524 $790.4800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 5.383333 $134.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 7 13.209524 $660.4800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.033333 $0.8300 $24.9800
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 9 11.776190 $588.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 8.200001 $205.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 68 90 2506.000001 $62650.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 849 1126 8442.709511 $422135.5000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 19.571429 $978.5700 $50.0000
INTR -T1013 INTERPRETER 37 42 244.457143 $12222.8500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 982 1443 10701.300778 $107013.0100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 74 108 417.364289 $29816.5300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 19 26 96.404761 $5514.3500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 85 119 490.661904 $35052.8800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 14 14 66.278572 $3788.4800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 2.000000 $130.0000 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 2.677778 $1221.0800 $456.0000
SENS -V5264 EARMOLD 23 28 27.588887 $496.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 127 160 609.928572 $43573.3100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 3 17.785715 $246.8700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1097 3414 23819.756276 $733438.2400 $30.7900
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Total 3556 24058.953896 $740156.5700 $30.7600
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Number of Children (Unduplicated) With at Least One Authorization 1144