Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3420 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 87 93 116.555559 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 87 93 116.555559 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 4.000000 $460.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 7 7 14.000000 $700.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 11 11 18.000000 $1160.0000 $64.4400
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.533333 $26.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 28 37 59.988889 $2999.4500 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $690.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 94 96 24.397706 $1219.9700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 1.750000 $87.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 81 81 28.750804 $718.7900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 12 16.149999 $807.5000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 2 1.500000 $75.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 12 16.266667 $406.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 8 10 18.166666 $908.3300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 0.333333 $16.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 5.950000 $148.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 1.933333 $96.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 9 14.949999 $747.5000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 2 1.500000 $75.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 6 8.850000 $221.2500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 42 54 1480.000000 $37000.0100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 877 1176 8679.957144 $433997.3400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 30 34 251.514286 $12575.7100 $50.0000
INTR -T1013 INTERPRETER 49 52 299.642858 $14982.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 984 1375 10040.414287 $100404.0300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 46 64 327.902380 $23425.3600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 6 6 14.928571 $1066.5000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 13 18 71.285714 $4077.5500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 3 4 13.785713 $788.5500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 46 63 263.173808 $18801.1400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 6 32.642857 $2332.0100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 14 20 62.107141 $3550.0500 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 4 18.304761 $1046.3000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 2.000000 $130.0000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 4 4.000000 $1824.0000 $456.0000
SENS -V5264 EARMOLD 21 26 40.077778 $721.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 82 103 453.399996 $32390.9500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 15 20 90.642854 $6475.5400 $71.4400
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Subtotal (Total Children Is Unduplicated) 1082 3316 22352.800877 $705404.2600 $31.5600
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Total 3420 22487.356436 $706564.2600 $31.4200
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Number of Children (Unduplicated) With at Least One Authorization 1147