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: 04-01-22 and 06-30-22 Date of Report: 08-08-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1911 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.250000 $9.2500 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 23 26 22.116665 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 24 27 22.366665 $9.2500 $0.4100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 12 8.833334 $428.4200 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 8 8 8.000000 $188.0000 $23.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 129 134 82.738112 $1944.3900 $23.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.505556 $22.7500 $45.0000
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Subtotal (Total Children Is Unduplicated) 148 155 100.077002 $2583.5600 $25.8200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 5.511111 $27555.5000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 11 11 9.933335 $2284.7100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 5 4.283333 $214.1700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 3.300000 $165.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 5.572221 $278.6100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 1.600000 $80.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 38 46 50.083333 $2504.1700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 34 35 42.088888 $2104.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 9 18.172222 $454.3100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 32 39 62.175398 $3108.7800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 21 22 43.317461 $2165.8700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 27 30 27.566664 $1378.3200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 17 17 20.938094 $1046.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.927777 $123.1900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 16 18 697.342857 $34867.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 309 341 1908.382529 $95419.1700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 288 318 1911.199224 $95560.0100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 387 537 2639.127754 $26391.2900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 21 111.028571 $7931.8800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 8.433334 $602.4800 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 29 33 188.861904 $13492.3000 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 22 24 103.880953 $7421.2400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 17 18 125.477777 $8964.1300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 0.555556 $39.6900 $71.4500
PHY -97110TL PT SESSION BY LICENSED PT 31 38 208.919047 $14925.1900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 19 20 88.580954 $6328.2300 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 27 30 198.433332 $14176.0900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 21.866667 $1562.1600 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 33 36 228.057143 $16292.4200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 46 49 302.652387 $21621.5000 $71.4400
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.000000 $69.4000 $13.8800
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Subtotal (Total Children Is Unduplicated) 720 1729 9048.269826 $409153.2600 $45.2200
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Total 1911 9170.713493 $411746.0700 $44.9000
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Number of Children (Unduplicated) With at Least One Authorization 737