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: 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 1523 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 17 18 15.238888 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 18 15.238888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 14 11.338888 $549.9300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.327778 $4.7800 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 100 105 62.912702 $1478.4600 $23.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.316667 $104.2500 $45.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.400000 $21.0300 $52.5700
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Subtotal (Total Children Is Unduplicated) 114 126 79.296035 $2269.6600 $28.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 9 7.144444 $35722.0000 $4999.9700
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.066667 $4.5900 $68.8900
AUDE -V5160 DISPENSING FEE BINAURAL 14 15 13.533333 $3112.6600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 8 6.250000 $312.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 9 11 12.116667 $605.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 8.166667 $408.3400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 8 8 5.884921 $294.2500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 24 33.355555 $1667.7800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 47 51 68.280955 $3414.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 6.461112 $161.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 26 61.886507 $3094.3300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 21 24 47.778572 $2388.9400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 16 17 15.900001 $795.0100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 21 23 41.818254 $2090.9100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.500000 $62.5000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 6.714285 $335.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 138 148 872.607940 $43630.3700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 401 483 2854.843652 $142742.0700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 161 217 969.664284 $9696.6400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 12 99.095239 $7079.3500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 11.666667 $833.4700 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 21 25 86.171429 $6156.1000 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 41 54 243.769048 $17414.8600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 11 14 84.990476 $6071.7200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 3 6.742857 $481.7100 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 22 27 117.533333 $8396.5900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 31 35 189.466667 $13535.4800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 16 97.861905 $6991.2500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 6 31.452380 $2246.9500 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 22 26 162.195239 $11587.2200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 64 73 482.845240 $34494.4500 $71.4400
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.000000 $83.2800 $13.8800
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Subtotal (Total Children Is Unduplicated) 672 1379 6655.764296 $365937.4400 $54.9800
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Total 1523 6750.299219 $368207.0900 $54.5500
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Number of Children (Unduplicated) With at Least One Authorization 685