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: 01-01-21 and 03-31-21 Date of Report: 05-04-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1244 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 15 19 22.866666 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 10.000000 $370.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 18 22 32.866666 $370.0000 $11.2600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 4.000000 $194.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 9 8.000000 $451.9200 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.4900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 10 10 3.494445 $48.4700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 50 54 29.094445 $689.5400 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.238889 $20.2700 $84.8400
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Subtotal (Total Children Is Unduplicated) 74 79 45.827779 $1427.6900 $31.1500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 9 16.961904 $84809.5000 $5000.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.266667 $19.1000 $71.6200
AUDE -V5160 DISPENSING FEE BINAURAL 11 12 7.700000 $1771.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 9 6.005556 $300.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 10 11 7.142857 $357.1500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 3.583333 $179.1700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 14 14 25.172224 $1258.6200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.933333 $48.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 25 26 44.167460 $2208.3800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 57 66 102.634126 $5131.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 8 20.983333 $524.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 9 7.905556 $395.2800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 22 25 56.270634 $2813.5300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 12.000000 $300.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 26 26 31.200002 $1560.0100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 26 29 35.727780 $1786.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 9.311111 $232.7800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.000000 $73.3200 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 143 164 911.596426 $45579.7600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 344 429 2569.339686 $128466.8500 $50.0000
INTR -T1013 INTERPRETER 1 1 0.700000 $35.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 48 59 242.811111 $2428.1100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 21 63.584127 $4542.4600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 11 12 81.914286 $5851.9400 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 1 2 12.571428 $898.1000 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 52 64 310.230160 $22162.8400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 9 9 53.892064 $3850.0500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 6 44.152382 $3154.2400 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 34 41 256.252380 $18306.6400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 16 65.219840 $4659.3000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 16 18 95.447620 $6818.7700 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.400000 $100.0200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 34 36 263.414287 $18818.3100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 2.283333 $31.6900 $13.8800
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Subtotal (Total Children Is Unduplicated) 640 1143 5364.775006 $369473.1800 $68.8700
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Total 1244 5443.469451 $371270.8700 $68.2000
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Number of Children (Unduplicated) With at Least One Authorization 651