Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 07-01-19 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 5185 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 20 20 22.555554 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 16.333333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 31 31 70.003175 $2590.1200 $37.0000
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Subtotal (Total Children Is Unduplicated) 53 53 108.892062 $2590.1200 $23.7900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 12 12 9.337444 $452.8700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 21 21 10.988890 $152.4200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 68 75 57.916664 $1372.6200 $23.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.400000 $63.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.216667 $139.9200 $115.0000
EXIT -EXIT EXIT ASSESSMENT 7 7 11.594444 $579.7200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 3.622222 $271.6700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 1.955555 $146.6600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 3.727778 $279.5900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 3.694444 $205.0400 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 20.433332 $1021.6600 $50.0000
SCREEN-T1023 SCREENING 3 3 14.380953 $719.0500 $50.0000
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Subtotal (Total Children Is Unduplicated) 118 139 143.268393 $5571.7000 $38.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 6.283334 $31417.0000 $5000.0500
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.088889 $4.4500 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 4.000000 $286.4400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 20 20 14.611112 $3360.5800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 65 58.424604 $2921.2400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 0.005556 $0.2800 $50.4000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 4.500000 $112.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 59 69 183.305555 $9165.2800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 9.857143 $246.4300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 117 152 331.450794 $16572.5500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 15 15 27.638888 $1381.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 35.048413 $876.2100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 94 119 287.185710 $14359.2600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 7 7 6.022223 $301.1200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.500000 $12.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 78 93 179.345238 $8967.2600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 17 18 18.522223 $926.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 14.666666 $366.6700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 8 16.233333 $1190.2300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 53 101 471.569841 $11789.2600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 43.740476 $2187.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 861 1409 14473.580152 $723679.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 104 107 597.114285 $29855.7300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1033 2251 20291.847882 $202918.5200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 86 139 1399.121421 $99953.2300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 8 8 50.628571 $3616.9000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 13 13 143.604763 $8214.2000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 34.857143 $1993.8300 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 23.714286 $1694.1500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 9 9 54.271429 $3877.1600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 93 151 1850.245234 $132181.5500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 11 11 99.166667 $7084.4700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 6 62.809523 $3590.1900 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 6.866667 $392.5000 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 12 13 50.695238 $3621.6700 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.377778 $24.5600 $65.0000
SENS -V5264 EARMOLD 1 1 0.755556 $13.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 93 123 1179.288891 $84248.4100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 13 13 62.214285 $4444.5800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 19 20 97.259523 $6948.2300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 62.019047 $860.8200 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $31.7300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1140 4993 42256.724053 $1425739.4900 $33.7400
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Total 5185 42508.884508 $1433901.3000 $33.7300
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Number of Children (Unduplicated) With at Least One Authorization 1153