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: 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 5034 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 4 4 4.022222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 4.022222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 734 761 786.428571 $18473.2100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 3.000000 $41.6100 $13.8700
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 56 61 65.457143 $3341.5900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 13.433333 $685.7700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 5.000000 $255.2500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 7 7 6.011111 $306.8700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 67 72 82.015873 $3653.8000 $44.5500
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Subtotal (Total Children Is Unduplicated) 804 928 965.346031 $27025.1900 $28.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.000000 $15000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 4.000000 $920.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 353 414 457.223796 $22861.1100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 34 38 29.855551 $1492.7600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 143 162 307.319044 $15365.9300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 174 194 180.095227 $9004.7000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.544444 $63.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1286 1656 16330.317051 $816515.8400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 19.666667 $983.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 4.571429 $45.7100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 99 124 800.357143 $57177.5300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 292 345 2313.383338 $132325.5100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 495 624 3421.142064 $244406.4600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 9 82.428572 $4711.6200 $57.1600
SENS -V5264 EARMOLD 9 9 9.000000 $162.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 389 465 3164.813891 $226094.2800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.500000 $371.8000 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 0.285714 $20.4100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 37 42 336.383335 $4669.0000 $13.8800
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Subtotal (Total Children Is Unduplicated) 1794 4102 27472.887266 $1552191.5900 $56.5000
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Total 5034 28442.255519 $1579216.7800 $55.5200
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Number of Children (Unduplicated) With at Least One Authorization 1811