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: 10-01-12 and 12-31-12 Date of Report: 02-16-13 Page: 1
Eligibility Filter: Program Patients
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 3 3 7.238095 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 3 7.238095 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 8 8 6.185388 $103.7900 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 8 8 6.444444 $58.7100 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 8 8 6.444444 $60.1900 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 7 5.807610 $126.2000 $21.7300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.377778 $9.5400 $25.2600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 2.044444 $50.0300 $24.4700
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 2.644444 $119.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 2.044444 $235.1100 $115.0000
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Subtotal (Total Children Is Unduplicated) 9 43 31.992996 $762.5600 $23.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.322222 $483.3000 $1499.9000
AUD -HA_FUP AUDIOLOGY SERVICES 7 7 13.526985 $676.3500 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1698 2252 4396.369229 $219819.3600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1702 2204 4316.680340 $215834.9200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1696 2195 4193.392242 $209670.5000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1699 2250 4237.359374 $211868.8500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 993 1274 9190.769852 $459539.0800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 234 328 2061.863492 $139959.4300 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 387 527 3706.462595 $251595.0300 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 0.511111 $255.5500 $499.9900
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 1.533333 $349.5900 $228.0000
SENS -V5264 EARMOLD 7 7 5.555555 $100.0000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 30 38 58.607142 $2930.3600 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 727 1015 6548.892880 $444539.2600 $67.8800
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Subtotal (Total Children Is Unduplicated) 1739 12101 38731.846352 $2157621.5600 $55.7100
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Total 12147 38771.077443 $2158384.1200 $55.6700
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Number of Children (Unduplicated) With at Least One Authorization 1739