Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 2286 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 3 3 4.133333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 4.133333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 5 7.077777 $98.1700 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 6 9.244444 $83.9400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 6 9.244444 $257.2700 $27.8300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 6 9.244444 $207.0700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 6 0.926027 $41.6700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 6 1.104109 $126.9700 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 3 3 3.000000 $150.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 16 17 17.000000 $867.8500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 8 8.000000 $408.4000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 77 79 79.000000 $3950.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 6.142857 $313.6000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 6.000000 $306.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 23 24 24.000000 $1225.2000 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 5.000000 $222.7500 $44.5500
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Subtotal (Total Children Is Unduplicated) 130 185 190.984102 $8564.4400 $44.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 1.322222 $6611.0000 $4999.9200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 2.166667 $108.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 4 8.899999 $445.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 3 6.300000 $451.1400 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 19 23 31.766667 $1588.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 318 492 1337.452388 $66872.6600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 201 277 828.283331 $41414.1600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 106 138 421.357140 $21067.8400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 254 313 828.874986 $41443.6800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 294 408 2203.127376 $110156.3900 $50.0000
INTR -T1013 INTERPRETER 13 19 174.400000 $8719.9900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 76 100 536.852378 $38352.7300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 9.857143 $704.1900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 22 26 218.419048 $12493.5700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 67 99 582.408337 $41607.2600 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.011111 $230.5300 $228.0000
SENS -V5264 EARMOLD 5 7 8.899999 $160.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 134 171 1092.709523 $78063.2400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 9.750000 $696.5400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 8 10 65.952382 $915.4200 $13.8800
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Subtotal (Total Children Is Unduplicated) 469 2098 8369.810697 $472102.1900 $56.4100
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Total 2286 8564.928132 $480666.6300 $56.1200
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Number of Children (Unduplicated) With at Least One Authorization 477