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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2470 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 1.966667 $72.7700 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 54 61 144.596826 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 55 62 146.563493 $72.7700 $0.5000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 0.511111 $12.0100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 2 0.511111 $7.0900 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 2 0.511111 $4.6400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 2 0.511111 $14.2200 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 2 0.511111 $43.3600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 2 0.511111 $26.1000 $51.0700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 4.285714 $321.4300 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 9 36.314287 $1815.7200 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 10 23 44.666667 $2295.6200 $51.3900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 90 126 173.526660 $8676.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 110 156 172.462342 $4311.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 71 81 110.085388 $5504.2700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 1.994445 $49.8600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 62 65 105.586975 $5279.3600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 47 53 60.333334 $3016.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 68 73 89.070460 $4453.5200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 4.994445 $124.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 809 1062 8499.723783 $424986.6200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 11 144.571427 $7228.5900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 144 181 1155.625388 $82557.9700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 26.552381 $1896.9100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 150 186 1535.580941 $109702.0100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 5 65.714285 $4694.6400 $71.4400
SENS -V5264 EARMOLD 1 2 0.511111 $9.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 294 364 3050.211888 $217907.4400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 15.857143 $1132.8300 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 8.714286 $622.5500 $71.4400
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Subtotal (Total Children Is Unduplicated) 1106 2385 15223.116682 $882205.2000 $57.9500
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Total 2470 15414.346842 $884573.5800 $57.3900
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Number of Children (Unduplicated) With at Least One Authorization 1158