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 06-30-21 Date of Report: 07-15-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3235 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 29 36 80.727778 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 4 18.533333 $685.7300 $37.0000
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Subtotal (Total Children Is Unduplicated) 32 40 99.261111 $685.7300 $6.9100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 12 10.988888 $532.9600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 12 10.833333 $611.9700 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.011111 $23.7500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 21 21 13.127778 $182.0800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 91 101 76.883338 $1822.1500 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.744444 $63.1500 $84.8300
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 5.688889 $284.4500 $50.0000
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Subtotal (Total Children Is Unduplicated) 139 153 121.733337 $3641.0100 $29.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 14 37.750793 $188754.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.855556 $142.7800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 3.527778 $252.6300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 19 21 18.961111 $4361.0500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 18 23 20.261112 $1013.0600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 34 36 27.999999 $1400.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 10 32.717460 $1635.8800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 20 22 87.475397 $4373.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 20.361904 $509.0500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 77 87 189.328570 $9466.4200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 97 126 319.617456 $15980.8600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 11 12 44.050000 $1101.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 26 28 71.261112 $3563.0600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 40 53 192.826982 $9641.3500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 17.400000 $435.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 59 70 170.631748 $8531.5900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 70 80 164.947617 $8247.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 14 23.277777 $581.9400 $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 21.714285 $542.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 7 27.945237 $1397.2600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 415 491 4640.840846 $232042.0700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 594 870 9695.300754 $484765.0600 $50.0000
INTR -T1013 INTERPRETER 1 1 3.733333 $186.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 344 455 2442.801578 $24428.0300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 70 548.387300 $39176.8000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 16 21 249.409523 $17817.8000 $71.4400
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 4.142857 $236.9700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 8 9 68.999997 $4929.3600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 90 133 1260.351580 $90039.5500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 36 44 444.696030 $31769.0800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 12 21 211.806349 $15131.4600 $71.4400
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 5.466667 $312.4800 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 7 7 6.300000 $450.0700 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 58 82 862.076186 $61586.7400 $71.4400
SENS -V5264 EARMOLD 1 1 0.933333 $16.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 34 48 371.951588 $26572.2600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 26 32 434.052380 $31008.7200 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 13 13 63.888892 $4564.2400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 87 116 1188.188890 $84884.2400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 14.733334 $204.5000 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 9.733334 $135.1000 $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) 1161 3042 24031.849502 $1412551.7600 $58.7800
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Total 3235 24252.843950 $1416878.5000 $58.4200
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Number of Children (Unduplicated) With at Least One Authorization 1171