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: 01-01-13 and 03-31-13 Date of Report: 05-17-13 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 4 4 5.685714 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 4 4 5.685714 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 9 10 3.757838 $63.0600 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 9 10 3.794444 $34.5700 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 10 3.794444 $35.4400 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 8 10 4.063394 $88.3000 $21.7300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.100000 $2.5300 $25.2600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 0.999999 $24.4700 $24.4700
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 9 3.266667 $147.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 7 2.127778 $244.7000 $115.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 10 62 21.904564 $640.0500 $29.2200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.211111 $1055.5000 $4999.7400
AUD -HA_FUP AUDIOLOGY SERVICES 7 9 9.565079 $478.2600 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1643 2268 4118.090475 $205904.5100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1644 2246 4057.030154 $202851.4800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1640 2233 3999.792856 $199989.6300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1640 2266 4025.740892 $201287.0100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 969 1295 8707.484967 $435373.7100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 247 362 1948.651983 $132274.3400 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 359 518 3413.557931 $231712.1700 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 2 2 0.477778 $238.9000 $500.0200
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.049315 $3.2000 $64.9800
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 4 1.500000 $342.0000 $228.0000
SENS -V5264 EARMOLD 8 10 4.616666 $83.1000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 28 37 37.144445 $1857.2300 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 663 928 5722.247420 $388425.7300 $67.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1658 12180 36046.161072 $2001876.7500 $55.5400
-------------------------------------------------------------------------------------------------------------------------------------
Total 12246 36073.751350 $2002516.8000 $55.5100
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1660