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: 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 1234 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 18 18 24.433334 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 4.933333 $182.5300 $37.0000
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Subtotal (Total Children Is Unduplicated) 21 21 29.366667 $182.5300 $6.2200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 3.083333 $149.5400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 9 6.494444 $366.8700 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 11 11 3.927779 $54.4800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 48 49 25.588887 $606.4500 $23.7000
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
SCREEN-T1023 SCREENING 1 1 2.366667 $118.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 73 75 43.461110 $1395.6800 $32.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 9 8.255555 $41277.5000 $4999.9700
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.833333 $41.6700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.294444 $92.6900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 6.277777 $1443.8700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 7 7.250000 $362.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 9 10 7.071428 $353.5800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 8 9 20.920634 $1046.0200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 4.285714 $107.1400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 23 31.904761 $1595.2400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 50 54 83.320631 $4166.0200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 10.983332 $274.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 12 12 16.372223 $818.6200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 26 29 46.788889 $2339.4500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 5.400000 $135.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 29 31 34.072222 $1703.6100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 33 34 39.394443 $1969.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.244444 $81.1100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.000000 $73.3200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 12.000000 $300.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 2.050000 $102.5000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 171 187 1074.942049 $53747.0900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 341 399 2314.730932 $115736.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 65 77 405.562694 $4055.6300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 23 123.276187 $8806.8500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 11 12 64.828569 $4631.3600 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 50 60 303.354756 $21671.7000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 16 18 131.430158 $9389.3700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 7 10 49.734920 $3553.0600 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 31 33 200.576186 $14329.1600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 16 106.058728 $7576.8300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 15 16 100.052380 $7147.7500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 25 31 192.388888 $13744.2700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 8.116666 $112.6600 $13.8800
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Subtotal (Total Children Is Unduplicated) 650 1138 5434.982467 $323903.7700 $59.6000
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Total 1234 5507.810244 $325481.9800 $59.0900
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Number of Children (Unduplicated) With at Least One Authorization 662