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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3457 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 60 72 80.287304 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 60 72 80.287304 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 7.000000 $810.6700 $115.8100
EXIT -EXIT EXIT ASSESSMENT 3 3 4.088889 $204.4500 $50.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 1 1.000000 $51.8500 $51.8500
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 29 38 44.777777 $6368.7300 $142.2300
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 33 48 56.866666 $7435.7000 $130.7600
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 0.988889 $49.4500 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 188 195 121.943235 $6097.2100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 10 10 5.005556 $250.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 107 112 70.481891 $1762.0600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 21 27 51.062698 $2553.1300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 3 3.600000 $180.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 12 15 23.202382 $580.0600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 14 20.733333 $1036.6700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 3 4.500000 $225.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 7 20.940477 $523.5100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 12 24.573809 $1228.6900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 2 2 2.100000 $105.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 8 6.592858 $164.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 2.850000 $142.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 13.485714 $337.1400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 26 33 828.857145 $20721.4200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 17 21 565.142859 $14128.5800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 838 1156 8391.519067 $419575.8000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 32 37 280.714286 $14035.7100 $50.0000
INTR -T1013 INTERPRETER 35 47 370.571429 $18528.5800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 910 1306 9452.152403 $94521.4900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 53 64 327.415873 $23560.8300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 7 8 37.380953 $2689.9400 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 8 12 37.447618 $2156.9900 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 5 5 29.000000 $1670.3900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 52 66 392.367260 $28234.7700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 7 24.250001 $1745.0200 $71.9600
PHY -97110HM PT SESSION BY PT ASST 13 22 76.011908 $4375.2400 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 6 26.892857 $1547.9500 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 1.000000 $71.9600 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 4 4 6.000000 $1377.6600 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 4 4.000000 $1836.8800 $459.2200
SENS -V5264 EARMOLD 19 25 33.900000 $614.6100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 49 67 524.928566 $37773.8700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 18 24 149.769046 $10777.3800 $71.9600
TRAV -TRAVS Travel by mile 1 1 6.000000 $2.6700 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1021 3337 21941.382113 $716109.7000 $32.6400
-------------------------------------------------------------------------------------------------------------------------------------
Total 3457 22078.536083 $723545.4000 $32.7700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1075