Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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: 10-01-15 and 12-31-15 Date of Report: 02-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 3432 FSPSA's found of which 102 had no frequency modifier field, FORCE FREQ MODIFIER to 0
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.505556 $7.5500 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.505556 $9.7100 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.505556 $5.2700 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.505556 $4.4200 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.505556 $11.0400 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.505556 $32.9300 $65.1500
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.505556 $11.5800 $22.9000
EXIT -EXIT EXIT ASSESSMENT 10 10 6.536986 $326.8500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 6 48.236508 $2411.8300 $50.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.427778 $21.8400 $51.0500
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Subtotal (Total Children Is Unduplicated) 17 24 58.740164 $2843.0200 $48.4000
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 11.714286 $585.7200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 130 169 14.266332 $713.2700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 29 31 1.795498 $44.8800 $24.9900
CONIF -CONIF CONSULT, FACE TO FACE 138 277 485.242170 $24262.0500 $50.0000
CONIP -CONIP CONSULT, PHONE 10 12 2.097032 $52.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 814 1087 7790.522984 $389526.7100 $50.0000
INTR -T1013 INTERPRETER 30 31 1146.225399 $57311.2700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 109 148 1019.490037 $72832.4700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 179 246 1766.152384 $126174.0600 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 276 368 2934.850348 $209665.9500 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 776 1037 8246.207554 $4123.0900 $0.5000
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Subtotal (Total Children Is Unduplicated) 1109 3407 23418.564024 $885291.8700 $37.8000
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Total 3431 23477.304188 $888134.8900 $37.8300
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Number of Children (Unduplicated) With at Least One Authorization 1109