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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2447 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 33 37 81.046033 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 33 37 81.046033 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.155556 $3.3200 $21.3600
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.155556 $1.2900 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.155556 $3.9400 $25.3200
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.155556 $12.0000 $77.1500
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.155556 $2.8900 $18.5600
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 13 45.457144 $2272.8600 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.050000 $2.5500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 15 21 48.584924 $2415.9400 $49.7300
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 6.428571 $321.4300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 142 179 172.978005 $8648.9200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 53 54 40.088591 $1002.2100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 66 71 60.200902 $3010.0500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 6.428571 $160.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 38 41 34.400185 $1720.0100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 47 52 40.488127 $2024.4100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 58 60 55.334125 $2766.7100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.377778 $84.4500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 23.000000 $575.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 951 1265 9088.100822 $454404.4400 $50.0000
INTR -T1013 INTERPRETER 3 5 38.571429 $1928.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 102 142 1029.166668 $73523.6000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 134 185 1335.538101 $95410.7700 $71.4400
SENS -V5264 EARMOLD 2 2 6.584127 $118.5200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 234 324 2475.923819 $176879.7800 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1172 2389 14416.609821 $822579.5500 $57.0600
-------------------------------------------------------------------------------------------------------------------------------------
Total 2447 14546.240778 $824995.4900 $56.7200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1194