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: 10-01-12 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 119 143 88.788879 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 119 143 88.788879 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 110 112 36.885706 $481.3500 $13.0500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 110 112 35.141261 $320.1300 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 108 109 35.130150 $328.1100 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 109 111 35.152372 $763.8400 $21.7300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 92 94 29.030151 $710.3500 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 104 118 385.944449 $23156.6900 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 11 7.103196 $319.6400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 13 13.406392 $1541.7200 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 11 12 2.511111 $125.5600 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 3 0.494445 $27.4400 $55.5100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 59 61 102.644448 $4978.2700 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 11 11 4.255555 $206.3900 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 63 69 79.444446 $3853.0600 $48.5000
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Subtotal (Total Children Is Unduplicated) 321 836 767.143682 $36812.5700 $47.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 21 23 46.433333 $69649.9500 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 16 17 55.523807 $2776.2000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 106 133 25.272228 $1263.6400 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 5 5 1.016668 $25.4200 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 196 243 92.644436 $4632.1800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 149 184 118.933325 $5946.6300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 0.427778 $10.7000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 95 124 106.371424 $5318.5500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 371 487 291.416647 $14570.7400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 6.133333 $153.3300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 21 25 157.904767 $3947.6300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 9.600000 $480.0000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 1.366666 $68.3300 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 5.200000 $130.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 847 1257 9859.823831 $492991.2900 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 20 20 94.591667 $4729.5900 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 18 19 162.038094 $8101.9100 $50.0000
INTR -INTR INTERPRETER 3 5 12.383333 $619.1700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 417 592 3237.610320 $219768.9900 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 11 11 56.733333 $3081.7500 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 635 871 4096.174976 $278048.2000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 8 8 46.833333 $2543.9800 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 11 11 10.911111 $5455.5500 $500.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 3 2.717504 $619.5900 $228.0000
SENS -V5264 EARMOLD 15 17 15.028614 $270.5100 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 17 28 71.494444 $3574.7200 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 12 14 41.065874 $2053.3000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 603 856 4610.469837 $312958.6600 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 30.933334 $408.3200 $13.2000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 1010 1702 341790.455526 $170895.2200 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 21 24 108.742857 $5437.1400 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 31 31 165.891666 $8294.5800 $50.0000
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Subtotal (Total Children Is Unduplicated) 1598 6722 365332.144066 $1628825.7400 $4.4600
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Total 7701 366188.076627 $1665638.3000 $4.5500
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Number of Children (Unduplicated) With at Least One Authorization 1707