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: 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 1640 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 2 2 1.188889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.188889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 561 587 614.449207 $14433.4100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 6 6.000000 $306.3000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.811111 $92.4600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 4.000000 $178.2000 $44.5500
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Subtotal (Total Children Is Unduplicated) 571 601 628.260318 $15075.2900 $24.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 342 401 454.147599 $22707.2800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 34 38 35.744445 $1787.2300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 168 188 413.792049 $20689.5300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 169 201 196.533329 $9826.6500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.377778 $59.4500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 74 83 802.714284 $40135.7100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 2 9.500000 $678.6800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 23 26 171.642857 $9817.9700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 35 40 188.360315 $13456.4700 $71.4400
SENS -V5264 EARMOLD 5 5 5.000000 $90.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 38 43 257.157538 $18371.3300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.000000 $457.6000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 6.035714 $83.7800 $13.8800
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Subtotal (Total Children Is Unduplicated) 483 1037 2554.005908 $143621.6700 $56.2300
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Total 1640 3183.455115 $158696.9500 $49.8500
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Number of Children (Unduplicated) With at Least One Authorization 918