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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2966 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 54 58 121.147626 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 54 58 121.147626 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.477778 $11.2200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.477778 $6.6300 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.477778 $4.3400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.477778 $13.3000 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.477778 $40.5400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.477778 $24.4000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.477778 $7.9800 $16.7000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 4 20.000000 $1000.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 11 33.000002 $1650.0200 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 12 22 56.344448 $2758.4200 $48.9600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 2 2.000000 $10000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.100000 $5.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 177 233 278.628247 $13931.4000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 86 88 66.840415 $1671.0100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 68 77 84.349206 $4217.4700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 53 56 81.039683 $4051.9900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 72 81.238889 $4061.9500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 3.000000 $75.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 68 69 100.501588 $5025.0800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 3.000000 $75.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1135 1480 11368.845174 $568443.0800 $50.0000
INTR -T1013 INTERPRETER 2 3 14.142857 $707.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 137 186 1240.587298 $88627.6600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 159 210 1616.182532 $115460.2500 $71.4400
SENS -V5264 EARMOLD 2 2 0.577778 $10.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 311 401 3425.085689 $244688.4800 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1407 2886 18366.119356 $1061050.9100 $57.7700
-------------------------------------------------------------------------------------------------------------------------------------
Total 2966 18543.611430 $1063809.3300 $57.3700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1446