Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1947 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 40 45 32.611113 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 40 45 32.611113 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.377778 $8.8800 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.377778 $8.8800 $23.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.377778 $8.8800 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 0.877778 $8.5900 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.377778 $10.8500 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.377778 $16.9100 $44.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.377778 $32.6000 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.377778 $7.8900 $20.8900
EXIT -EXIT EXIT ASSESSMENT 35 35 55.850000 $2792.5000 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.500000 $178.6800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 42 50 66.872224 $3170.2600 $47.4100
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 3.133333 $156.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 193 259 159.835750 $7991.8900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 3.000000 $150.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 10 10.104761 $252.6200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 551 750 1984.845232 $99242.2800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 3 4 13.933333 $696.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 5 14.066666 $351.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 267 331 749.935716 $37496.8000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 9.000000 $225.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 92 118 273.640945 $13682.0500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.433333 $10.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 275 337 737.283329 $36864.1500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 6.428571 $321.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 4.366667 $109.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 29.323809 $1466.2000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9 11 89.399998 $4470.0000 $50.0000
PHY -97110 PT SESSION BY LICENSED PT 3 4 33.571428 $2398.3400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 19.142857 $1367.5600 $71.4400
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Subtotal (Total Children Is Unduplicated) 641 1852 4141.445728 $207253.2900 $50.0400
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Total 1947 4240.929065 $210423.5500 $49.6200
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Number of Children (Unduplicated) With at Least One Authorization 679