Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 1629 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 0.866667 $32.2400 $37.2000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 6 6 3.944443 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 7 4.811110 $32.2400 $6.7000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 18 19 19.000000 $370.6900 $19.5100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 13 14 14.000000 $205.5200 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 12 13 13.000000 $114.5300 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 12 13 13.000000 $375.9600 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 12 13 13.000000 $273.5200 $21.0400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 7 7 7.000000 $525.9100 $75.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 11 21.633335 $1081.6800 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 4.000000 $205.6400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 9 10 10.000000 $514.1000 $51.4100
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Subtotal (Total Children Is Unduplicated) 46 106 116.633335 $3770.3700 $32.3300
EI Services, Class # 03
CONIF -CONIF CONSULT, ITDS FACE TO FACE 432 607 832.085723 $41604.3500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 57 73 77.249205 $3862.4500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 153 197 224.744442 $11237.2100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 262 337 438.731750 $21936.6000 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 9.119048 $455.9500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 0.177778 $8.8900 $50.0100
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 143 172 1567.631739 $78381.6500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 34 37 333.142858 $23972.9700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 28 29 192.321429 $13839.4300 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 54 60 497.038097 $35766.8500 $71.9600
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Subtotal (Total Children Is Unduplicated) 618 1516 4172.242069 $231066.3500 $55.3800
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Total 1629 4293.686514 $234868.9500 $54.7000
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Number of Children (Unduplicated) With at Least One Authorization 635