Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 2102 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 14 14 16.611110 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 14 16.611110 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 99 133 91.148550 $4420.6900 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.666667 $15.6700 $23.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.355556 $16.0000 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.355556 $40.8900 $115.0100
EXIT -EXIT EXIT ASSESSMENT 3 3 4.000000 $200.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 104 139 96.526329 $4693.2500 $48.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 16 19 36.238889 $181194.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.155556 $7.7800 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 7 1.988889 $99.4500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.355556 $24.4900 $68.8700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 133 168 94.302176 $4715.0800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 98 119 80.322226 $4016.1300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 61 70 97.198407 $4859.9000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 81 107 134.511105 $6725.5300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 101 116 109.164276 $5458.1800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 97 109 113.594439 $5679.7000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.200000 $55.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 58 65 79.125398 $3956.2800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 43 47 43.361114 $2168.0700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 131 144 144.994440 $7249.6900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 131 151 148.550788 $7427.5200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 5.511110 $137.7800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4 4 16.155555 $807.7800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 26.888889 $1344.4500 $50.0000
INTR -T1013 INTERPRETER 1 2 10.071429 $503.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 405 799 2672.038084 $26720.3900 $10.0000
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.733333 $52.3900 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 26.647619 $1903.7000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 0.466667 $33.3400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 2 0.400000 $28.5800 $71.4400
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Subtotal (Total Children Is Unduplicated) 615 1949 3844.975945 $265169.2200 $68.9700
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Total 2102 3958.113384 $269862.4700 $68.1800
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Number of Children (Unduplicated) With at Least One Authorization 629