Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2338 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 2 2 3.266666 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.022222 $37.8200 $37.0000
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Subtotal (Total Children Is Unduplicated) 3 3 4.288888 $37.8200 $8.8200
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.833333 $29.5200 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 2.833333 $24.7900 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 2.833333 $61.8800 $21.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $22.9000 $22.9000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 2.000000 $250.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 28 29 34.021461 $1736.8100 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 10 10 7.066514 $360.7400 $51.0500
SCREEN-T1023 SCREENING 49 49 38.440119 $1922.0100 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 6.082192 $310.5000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 24 24 20.200000 $1031.2100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 4 4 4.000000 $204.2000 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 114 135 125.310285 $6155.6100 $49.1200
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.833333 $91.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 15 27.008296 $1350.4200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.066667 $26.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 308 470 1143.419399 $57170.9300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.533333 $13.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 202 286 746.672152 $37333.6300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 114 153 428.344439 $21417.2000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 265 330 876.724605 $43836.2400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.266666 $31.6700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 5 15.376647 $768.8400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 294 396 2481.218477 $124060.9700 $50.0000
INTR -T1013 INTERPRETER 2 2 30.057143 $1502.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 92 129 635.084917 $45370.5200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 22 31 170.795239 $9769.4900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 81 105 579.072617 $41368.9700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 7 61.423811 $3510.9800 $57.1600
SENS -V5264 EARMOLD 1 1 1.222222 $22.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 204 259 1739.923814 $124300.1500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 25.911904 $359.6600 $13.8800
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Subtotal (Total Children Is Unduplicated) 526 2200 8966.955681 $512306.1600 $57.1300
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Total 2338 9096.554854 $518499.5900 $57.0000
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Number of Children (Unduplicated) With at Least One Authorization 530