Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 1347 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 30 34 31.796028 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 30 34 31.796028 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.4900 $23.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 3 3.000000 $50.1000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $22.4000 $22.4000
EXIT -EXIT EXIT ASSESSMENT 126 126 191.977301 $9598.8500 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.013699 $0.7600 $55.5100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.511111 $77.1400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.511111 $77.1400 $51.0500
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Subtotal (Total Children Is Unduplicated) 131 139 202.524333 $9984.5200 $49.3000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 111 155 152.834136 $7641.7400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 21 24 41.932939 $1048.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 364 466 1492.229783 $74611.5800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 2.833333 $141.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 5 6.866667 $171.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 159 196 483.619060 $24181.0300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 3.066667 $76.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 74 96 255.100005 $12755.0200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 160 197 528.700018 $26435.0900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 13.971428 $349.2800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12 15 98.314285 $4915.7300 $50.0000
INTR -T1013 INTERPRETER 4 5 7.428571 $371.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 7.428571 $530.7000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 7.142857 $510.2900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.428571 $316.3800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 37.428572 $2673.8900 $71.4400
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Subtotal (Total Children Is Unduplicated) 436 1174 3143.325463 $156730.4800 $49.8600
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Total 1347 3377.645824 $166715.0000 $49.3600
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Number of Children (Unduplicated) With at Least One Authorization 522