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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2484 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 24 28 57.382844 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 24 28 57.382844 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.022222 $21.8200 $21.3500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.022222 $8.4400 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.022222 $25.8700 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.022222 $78.8400 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.022222 $18.9600 $18.5500
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 15 22 60.839681 $3041.9900 $50.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 2.366667 $120.8200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 19 30 69.317458 $3367.8000 $48.5900
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.428571 $121.4300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 167 213 197.997092 $9899.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 65 66 37.099995 $927.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 53 62 50.089683 $2504.4900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 24 20.500001 $1025.0100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 49 31.562002 $1578.0900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 51 56 46.126192 $2306.3200 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 20.285715 $507.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 938 1241 9169.549208 $458477.8100 $50.0000
INTR -T1013 INTERPRETER 8 11 60.165078 $3008.2600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 99 141 1090.704761 $77919.9900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 149 205 1433.580163 $102414.9800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 1.600000 $91.4600 $57.1600
SENS -V5264 EARMOLD 2 2 3.450793 $62.1100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 252 351 2705.095240 $193252.1200 $71.4400
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Subtotal (Total Children Is Unduplicated) 1194 2426 14870.234494 $854096.5800 $57.4400
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Total 2484 14996.934796 $857464.3900 $57.1800
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Number of Children (Unduplicated) With at Least One Authorization 1207