Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2086 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 75 80 66.265868 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 75 80 66.265868 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 27 41 43.398412 $2104.8200 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 6.066667 $174.2400 $28.7200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.487671 $56.0900 $115.0100
OCTH -97167 OT EVAL HIGH COMPLEXITY 51 69 40.465601 $2065.7600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 64 88 38.963473 $1989.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 94 118 74.171995 $3786.4900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 202 323 204.553819 $10221.0400 $49.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 27 37 30.172146 $150861.0000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 48 60 91.744445 $4587.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 144 178 227.134914 $11356.7100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 80 109 138.422221 $6921.1100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 192 258 322.430155 $16121.4900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 457 693 3699.211101 $184960.7300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 12.190476 $609.5200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 57 86 527.038091 $37651.6700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 67 111 538.876187 $38497.3000 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.487671 $111.2000 $228.0100
SENS -V5264 EARMOLD 2 2 0.991780 $17.8500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 101 143 639.414290 $45679.8400 $71.4400
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Subtotal (Total Children Is Unduplicated) 661 1683 6234.246811 $497682.3000 $79.8300
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Total 2086 6505.066498 $507903.3400 $78.0800
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Number of Children (Unduplicated) With at Least One Authorization 727