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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2898 FSPSA's found of which 33 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 3 5 6.444444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 5 6.444444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.955556 $18.3500 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.955556 $9.9600 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.955556 $8.3600 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.955556 $20.8700 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.955556 $62.2500 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.955556 $21.8800 $22.9000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 13 56.474601 $2823.7400 $50.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.505556 $25.8100 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.072222 $3.6900 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.216667 $11.0600 $51.0600
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Subtotal (Total Children Is Unduplicated) 13 23 63.002382 $3005.9600 $47.7100
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.955556 $47.7800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 134 163 25.689775 $1284.4800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 56 66 16.844738 $421.1100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 121 264 498.995950 $24949.8100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 9 8.222582 $205.5700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 17 18 23.272004 $1163.5900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 16 18 16.011111 $800.5500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 20 20 20.911904 $1045.5900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.714286 $42.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 820 1087 7497.504734 $374875.2900 $50.0000
INTR -T1013 INTERPRETER 9 9 182.714286 $9135.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 119 157 1095.530952 $78264.7400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 167 233 1687.010315 $120520.0300 $71.4400
SENS -V5264 EARMOLD 1 1 0.900000 $16.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 281 384 2931.010313 $209391.4000 $71.4400
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 346 439 2279.317443 $1139.6600 $0.5000
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Subtotal (Total Children Is Unduplicated) 1098 2870 16286.605949 $823304.3600 $50.5500
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Total 2898 16356.052775 $826310.3200 $50.5200
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Number of Children (Unduplicated) With at Least One Authorization 1101