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: 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 4412 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 11 11 27.397620 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 15.571429 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 13 13 42.969049 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 60 73 105.043651 $5094.6200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 14 15 13.633334 $770.1500 $56.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 15 17 9.033336 $214.1000 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 20 22 25.083332 $2128.0600 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 3.000000 $67.2000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 14 15 13.049999 $587.2500 $45.0000
EXIT -EXIT EXIT ASSESSMENT 62 66 94.456392 $4722.8200 $50.0000
SCREEN-T1023 SCREENING 20 24 16.122221 $806.1100 $50.0000
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.944444 $47.2200 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 193 236 280.366709 $14437.5100 $51.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 46 54.833335 $274167.5000 $5000.0200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.177778 $8.8900 $50.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 10.111111 $724.0600 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 1.355556 $97.0700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 5 7 11.572222 $2661.6100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 137 167 125.950007 $6297.5400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 4.666667 $233.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 6.500000 $162.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 109 134 147.861113 $7393.0700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 4 5 8.394444 $419.7200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 172 190 182.080160 $9104.0200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 6 7 3.411110 $170.5500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.747222 $43.6800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 143 163 151.131354 $7556.6000 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 3 3 0.994444 $49.7200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 257 317 270.454758 $13522.7300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 8 9 7.122222 $356.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 6 4.544444 $113.6100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 0.238889 $11.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 607 781 5219.476978 $260973.8500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 36 38 275.392064 $13769.6000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 863 1957 8010.261096 $80102.6100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 85 104 693.541265 $49546.5800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 8 8 56.776190 $4056.0900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 4.387301 $250.9500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 9.571429 $547.4800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 14.714286 $1051.1800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 16.428571 $1173.6600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 59 68 344.415077 $24605.0000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 8 8 63.180953 $4513.6500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 15.433334 $882.1700 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 5.533333 $395.3000 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 4.761110 $340.1300 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 1.011111 $461.0600 $456.0000
SENS -V5264 EARMOLD 1 2 1.011111 $18.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 77 90 472.916663 $33785.1600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 24.857143 $1775.7900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 5.922222 $423.0800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 71.014285 $985.6800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.571429 $21.1400 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 872 4163 16304.323787 $802772.6200 $49.2400
-------------------------------------------------------------------------------------------------------------------------------------
Total 4412 16627.659545 $817210.1300 $49.1500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 880