Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 4665 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 7 7 5.888888 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 13.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 18.888888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 63 77 81.916671 $3972.9800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 12 12 9.706164 $548.3000 $56.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 13 13 8.150002 $193.1600 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 13 16 20.322222 $1724.1400 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.400000 $31.3600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 20 20 18.716667 $842.2500 $45.0000
EXIT -EXIT EXIT ASSESSMENT 91 99 159.501749 $7975.0900 $50.0000
SCREEN-T1023 SCREENING 21 23 17.911111 $895.5600 $50.0000
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.088889 $3.2000 $35.9800
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Subtotal (Total Children Is Unduplicated) 215 263 317.713475 $16186.0300 $50.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 46 57 79.447946 $397240.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.544444 $27.2200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 4.666667 $334.1800 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 3.111112 $222.7900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.505556 $346.2900 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 148 175 151.215045 $7560.8300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 3.255556 $81.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 106 131 130.285712 $6514.2800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 173 203 188.813115 $9440.6500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 0.930556 $23.2700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 148 171 178.719444 $8935.9700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 271 327 275.637309 $13781.9100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 8 9.466668 $236.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 669 885 5968.979355 $298448.9600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 28 28 73.557143 $3677.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 880 2082 8588.339722 $85883.4100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 89 112 716.265080 $51169.9600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 8.714286 $622.5500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 5 33.911111 $1939.7100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 1.000000 $57.2000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 68 88 463.998414 $33148.0700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 4 4 4.933333 $352.4400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 6 27.583334 $1576.6700 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 1.211111 $552.2600 $456.0000
SENS -V5264 EARMOLD 1 1 1.011111 $18.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 65 80 433.710315 $30984.2700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 5.266667 $376.2500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.888889 $508.4500 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 43.514286 $603.9800 $13.8800
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Subtotal (Total Children Is Unduplicated) 883 4394 17408.483287 $954665.6600 $54.8400
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Total 4665 17745.085650 $970851.6900 $54.7100
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Number of Children (Unduplicated) With at Least One Authorization 890