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 214 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 27 29 60.755556 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 29 60.755556 $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
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Subtotal (Total Children Is Unduplicated) 2 6 1.077780 $38.4300 $35.6600
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 49 65 55.607240 $2780.3600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 13 13 7.411952 $185.3000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 19 19 14.415980 $720.7900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 14 13.416058 $670.8000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 19 21 15.946574 $797.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 14 14 18.311110 $915.5500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.966667 $49.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14 14 69.571427 $3478.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 8 48.857143 $3490.3700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1 1 9.285714 $663.3700 $71.4400
SENS -V5264 EARMOLD 1 1 0.155556 $2.8000 $18.0100
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 6 36.000000 $2571.8300 $71.4400
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Subtotal (Total Children Is Unduplicated) 104 179 297.373992 $16647.6600 $55.9800
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Total 214 359.207328 $16686.0900 $46.4500
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Number of Children (Unduplicated) With at Least One Authorization 130