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: 07-01-20 and 09-30-20 Date of Report: 10-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1491 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 14 14 16.316666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 14 16.316666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 7 5.905555 $286.4200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 1.694444 $23.5000 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 48 52 26.616665 $630.8100 $23.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.455556 $20.5000 $45.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
SCREEN-T1023 SCREENING 2 2 3.322223 $166.1200 $50.0000
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Subtotal (Total Children Is Unduplicated) 66 70 40.994443 $1283.8400 $31.3200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 9.511111 $47555.5000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.022222 $51.1100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 5.327778 $1225.3900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 5 6.000000 $300.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 6 6 5.285714 $264.2900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 13.295237 $664.7600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 6 7 10.678571 $533.9300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 14.142857 $353.5700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 45 46 71.871427 $3593.5600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 38 42 56.151589 $2807.6000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 2.966666 $74.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 18 35.583332 $1779.1600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 18 20 29.305556 $1465.2800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 35 37 72.898413 $3644.9200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 32 34 41.432539 $2071.6200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 4.133333 $103.3300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 9.714285 $242.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 7 26.895237 $1344.7600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 284 308 1676.446412 $83822.3700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 257 288 1620.249982 $81012.5300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 260 316 1329.421418 $13294.2300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 37 40 270.504759 $19324.8800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 7 7 49.914285 $3565.8800 $71.4400
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 4.142857 $236.9700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 3 3 17.857142 $1275.7200 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 40 45 242.302379 $17310.1000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 31 33 233.271427 $16664.9300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 9 9 72.780952 $5199.4800 $71.4400
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 5.466667 $312.4800 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 23 27 137.899997 $9851.5800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 26 155.976189 $11142.9500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 14 15 132.952380 $9498.1200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 26 27 173.857143 $12420.3700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 9.783333 $135.7900 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 7.142857 $264.2900 $37.0000
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Subtotal (Total Children Is Unduplicated) 648 1407 6557.186046 $353480.0800 $53.9100
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Total 1491 6614.497155 $354763.9200 $53.6300
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Number of Children (Unduplicated) With at Least One Authorization 656