Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2752 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 76 82 298.493650 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 76 82 298.493650 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 3.000000 $345.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 28 28 63.142857 $3157.1500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 3.066667 $46.0000 $15.0000
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Subtotal (Total Children Is Unduplicated) 32 32 69.209524 $3548.1500 $51.2700
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 8 13.655555 $682.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 21 26.922223 $1346.1200 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $690.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 62 64 18.806759 $940.4100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 2 8.576985 $428.8500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 38 40 13.077691 $326.9700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 10 20.871426 $1043.5600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 4.733334 $236.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 6 10.800001 $270.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 12.271428 $613.5700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 7 11.633334 $290.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 1.533333 $76.6700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 2 2 4.733334 $236.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.700000 $17.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 9.199998 $459.9900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 3.066666 $76.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 58 66 1982.857146 $49571.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 609 730 5946.409489 $297320.9400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 117 135 1010.780955 $50539.0800 $50.0000
INTR -T1013 INTERPRETER 31 35 264.095238 $13204.7600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 819 1105 9007.433286 $90074.4700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 65 304.283337 $21737.9800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 11 13 46.769048 $3341.1700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 12 70.800001 $4049.7600 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 3 3 2.378571 $136.0600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 70 92 456.750008 $32630.1700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 10 12 55.959526 $3997.7400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 14 16 62.328572 $3562.7000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 2 14.214286 $812.4900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 4.320548 $280.8400 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 3 3 3.000000 $684.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 4 3.500000 $1596.0000 $456.0000
SENS -V5264 EARMOLD 17 20 27.944445 $503.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 96 112 544.354770 $38888.6900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 23 23 97.714287 $6980.7100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.571429 $375.8800 $57.2000
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.357143 $25.5100 $71.4300
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 26.785714 $371.7900 $13.8800
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Subtotal (Total Children Is Unduplicated) 929 2638 20103.189866 $628422.3700 $31.2600
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Total 2752 20470.893040 $631970.5100 $30.8700
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Number of Children (Unduplicated) With at Least One Authorization 979