Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 5894 FSPSA's found of which 1091 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
Service Coordination, Class # 01
TCM -T1017TL TARGETED CASE MANAGEMENT 13 13 9.877777 $365.4700 $37.0000
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Subtotal (Total Children Is Unduplicated) 13 13 9.877777 $365.4700 $37.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 213 214 95.546493 $1426.5000 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 217 229 99.549672 $1911.3500 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 211 213 94.363160 $983.2600 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 209 210 93.524272 $818.3300 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 4 4 1.250000 $10.0800 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 209 212 93.457604 $2041.1000 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 107 108 47.218721 $3075.8300 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 206 206 91.368716 $2092.3300 $22.9000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 17 20 11.805557 $602.6800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 7 3.111110 $158.8200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 36 39 37.446034 $1911.6300 $51.0500
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Subtotal (Total Children Is Unduplicated) 354 1462 668.641339 $15031.9000 $22.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.511111 $2555.5000 $4999.8900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 39 28.351187 $1417.5500 $50.0000
CONIF -CONIF CONSULT, FACE TO FACE 234 481 445.277774 $22263.8700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 912 1231 11502.078134 $575104.4400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 869 1747 1359.410808 $13594.0600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 191 228 1555.084948 $111095.2600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.071429 $290.0800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 313 377 2167.038935 $154813.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 5.142858 $293.9600 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 265 308 2219.245256 $158542.9200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 41.214286 $572.0500 $13.8800
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Subtotal (Total Children Is Unduplicated) 1211 4419 19328.426726 $1040542.9000 $53.8300
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Total 5894 20006.945842 $1055940.2700 $52.7800
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Number of Children (Unduplicated) With at Least One Authorization 1231