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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3307 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 69 78 104.152376 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 69 78 104.152376 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 7 8.655555 $1002.3900 $115.8100
EXIT -EXIT EXIT ASSESSMENT 4 4 13.123810 $656.1900 $50.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 2 1.000000 $51.8500 $51.8500
MED -99204 OUTPATIENT VISIT, NEW, 45 MINS 1 1 0.888889 $99.4900 $111.9200
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 21 30 34.955554 $4971.7100 $142.2300
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Subtotal (Total Children Is Unduplicated) 27 44 58.623808 $6781.6300 $115.6800
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 7 11.188888 $559.4400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 5 5.000000 $1158.1000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 158 167 93.147279 $4657.4100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 16 16 7.590874 $379.5500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 87 90 53.771658 $1344.2900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 19 23 44.830952 $2241.5500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 0.966667 $48.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 11 13 20.564286 $514.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 12 26.433333 $1321.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 8 12.146429 $303.6600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 10 20.416667 $1020.8400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 5.233333 $130.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 4.566666 $228.3300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.966667 $48.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 6.490477 $162.2600 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 28 35 1211.142861 $30278.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 23 32 1002.285715 $25057.1500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 3.747619 $187.3800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 813 1096 8359.647602 $417982.7700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 29 41 255.761906 $12788.1000 $50.0000
INTR -T1013 INTERPRETER 36 40 363.464284 $18173.2100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 894 1251 9581.133317 $95811.4200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 44 59 360.504764 $25941.9200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 9 12 60.294842 $4338.8100 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 7 10 47.061903 $2710.7700 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 16.428572 $946.2800 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 49 75 400.577981 $28825.5500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 4 5 33.857144 $2436.3500 $71.9600
PHY -97110HM PT SESSION BY PT ASST 13 13 69.952381 $4026.4500 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 5 31.035715 $1786.4100 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 1.000000 $71.9600 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 5 6 7.633333 $1752.6800 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 5 5.000000 $2296.1000 $459.2200
SENS -V5264 EARMOLD 18 23 27.144443 $492.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 57 77 522.009523 $37563.8100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 20 25 135.978574 $9785.0100 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.350000 $20.1600 $57.6000
TRAV -TRAVS Travel by mile 1 1 6.133333 $2.7300 $0.4400
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Subtotal (Total Children Is Unduplicated) 1014 3185 22815.459988 $737394.4000 $32.3200
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Total 3307 22978.236172 $744176.0200 $32.3900
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Number of Children (Unduplicated) With at Least One Authorization 1072