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: 10-01-21 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 1512 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 11 12 21.304763 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 11 12 21.304763 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 7.494444 $363.4800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.500000 $11.7500 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 1.661110 $24.2200 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 81 83 76.124598 $1788.9200 $23.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.000000 $90.0000 $45.0000
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Subtotal (Total Children Is Unduplicated) 97 101 88.780152 $2334.0700 $26.2900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 5.005555 $25027.5000 $4999.9500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.511111 $35.1900 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 15 15 11.772222 $2707.6100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 5 5.000000 $250.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 8 9 31.990476 $1599.5300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 5 6.399999 $320.0000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 11 12 34.630951 $1731.5400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 21 23 33.133334 $1656.6700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 46 49 83.880953 $4194.0400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 4.355555 $108.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 16 18 34.352381 $1717.6200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 29 34 52.323810 $2616.1900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 19 19 19.005555 $950.2800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 26 26 37.915873 $1895.7900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.944444 $73.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 136 158 963.956349 $48197.8600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 447 544 3473.130935 $173656.6300 $50.0000
INTR -T1013 INTERPRETER 1 1 2.857143 $142.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 132 176 715.514284 $7155.1500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 14 68.061905 $4862.3400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 8 8 33.157143 $2368.7400 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 19 23 86.028571 $6145.8800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 56 61 454.155556 $32444.9000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 7 8 47.700000 $3407.7000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 4 5 11.228572 $802.1800 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 14 16 49.147617 $3511.0900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 25 30 166.980949 $11929.1200 $71.4400
SENS -V5264 EARMOLD 1 1 1.133333 $20.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 14 74.799999 $5343.7200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 6 33.152382 $2368.4100 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 20 23 150.107935 $10723.7200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 68 78 556.095236 $39727.4600 $71.4400
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 2 6.133333 $85.1300 $13.8800
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Subtotal (Total Children Is Unduplicated) 734 1399 7257.563461 $397827.7100 $54.8200
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Total 1512 7367.648376 $400161.7800 $54.3100
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Number of Children (Unduplicated) With at Least One Authorization 741