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: 07-01-21 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 3853 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 42 48 73.626983 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.833333 $67.8300 $37.0000
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Subtotal (Total Children Is Unduplicated) 44 50 75.710316 $77.0800 $1.0200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 21 17.666667 $856.8400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 3 3.000000 $167.1300 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 8 8 8.000000 $188.0000 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.011111 $23.7600 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 10 10 5.183333 $75.5700 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 195 208 217.013491 $5099.8200 $23.5000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.250000 $21.2100 $84.8400
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.822222 $127.0000 $45.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 2.000000 $102.1000 $51.0500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.400000 $21.0300 $52.5700
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Subtotal (Total Children Is Unduplicated) 233 258 258.346824 $6737.9500 $26.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 16 17.326985 $86635.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.966667 $66.5700 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 22 23 24.988889 $5747.4500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 20 27 23.783333 $1189.1700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 25 30 61.869047 $3093.4600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 12 12 33.500000 $1675.0000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 18 21 80.433334 $4021.6800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 66 80 158.255554 $7912.7700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 89 110 270.403966 $13520.1900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 18 19 41.741271 $1043.5400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 58 162.269844 $8113.5100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 47 60 218.817461 $10940.8700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 48 53 91.355554 $4567.7700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 54 59 138.760317 $6938.0200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 11.905556 $297.6400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 16 18 719.628569 $35981.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 429 522 4648.548390 $232427.4500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 638 976 11429.115849 $571455.8200 $50.0000
INTR -T1013 INTERPRETER 2 2 11.433333 $571.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 476 748 5169.753130 $51697.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 32 41 377.417459 $26962.7000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 12 14 110.476189 $7892.4100 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 42 59 452.247614 $32308.5800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 89 121 1171.994444 $83727.3100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 23 29 253.377775 $18101.3000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 6 36.074602 $2577.1600 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 43 59 457.247614 $32665.7800 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 62 73 568.604761 $40621.1300 $71.4400
SENS -V5264 EARMOLD 1 1 3.177778 $57.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 39 51 484.817455 $34635.3700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 14 17 187.580952 $13400.7900 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 49 68 679.085713 $48513.9000 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 118 157 1935.504762 $138272.4500 $71.4400
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 3 23.866666 $331.2700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1200 3545 30059.330833 $1528063.8500 $50.8300
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Total 3853 30393.387973 $1534878.8900 $50.5000
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Number of Children (Unduplicated) With at Least One Authorization 1223