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 3197 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
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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 1 1 1.000000 $56.4900 $56.4900
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 3.000000 $254.5200 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $22.4000 $22.4000
EXIT -EXIT EXIT ASSESSMENT 62 66 94.456392 $4722.8200 $50.0000
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.944444 $47.2200 $50.0000
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Subtotal (Total Children Is Unduplicated) 120 144 205.444487 $10198.0600 $49.6400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 16 17 29.600000 $148000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.177778 $8.8900 $50.0100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.350000 $25.0600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.466667 $107.3400 $230.0200
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 27 32 227.339685 $11366.9900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 22.485714 $1124.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 863 1957 8010.261096 $80102.6100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 18.311110 $1308.1400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.000000 $142.8800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 14.966667 $1069.2200 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 6 29.980953 $2141.8400 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.571429 $21.1400 $37.0000
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Subtotal (Total Children Is Unduplicated) 864 3040 9271.607933 $290853.5000 $31.3700
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Total 3197 9520.021469 $301051.5700 $31.6200
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Number of Children (Unduplicated) With at Least One Authorization 873