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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1892 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 90 97 60.278835 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 90 97 60.278835 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 34 48 36.991628 $1794.0900 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 9.500000 $264.3900 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 1.326027 $152.4900 $115.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.505556 $25.8100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 40 48 32.636315 $1666.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 3 3.000000 $153.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 59 76 45.394278 $2317.4200 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.277778 $14.1800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 63 74 42.055562 $2146.9700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.377778 $16.8300 $44.5500
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Subtotal (Total Children Is Unduplicated) 161 261 173.064922 $8602.4700 $49.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 35 24.185389 $120927.5000 $5000.0200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 96 101 97.866671 $4893.3600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 1.822222 $91.1100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 133 168 273.170626 $13658.4900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 6.711110 $335.5500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 102 138 211.808731 $10590.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 243 296 374.154755 $18707.7100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 7 9 7.733332 $386.6600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 445 538 3348.366669 $167418.4100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 14 15 108.666667 $5433.3300 $50.0000
INTR -T1013 INTERPRETER 1 1 9.100000 $455.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 38 47 325.780952 $23273.7900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 63 85 568.214285 $40593.2400 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 7.142857 $510.2900 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 4 5 1.517808 $346.0600 $228.0000
SENS -V5264 EARMOLD 4 5 1.857534 $33.4400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 65 84 551.922223 $39429.3200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 5.666666 $78.6500 $13.8800
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Subtotal (Total Children Is Unduplicated) 598 1534 5925.688497 $447162.3400 $75.4600
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Total 1892 6159.032254 $455764.8100 $74.0000
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Number of Children (Unduplicated) With at Least One Authorization 683