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
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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 2 2 0.511111 $8.5800 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.100000 $0.9100 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.100000 $0.9300 $9.3400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.100000 $2.5300 $25.2600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.411111 $10.0600 $24.4700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.205556 $9.2500 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.205556 $23.6400 $115.0200
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Subtotal (Total Children Is Unduplicated) 2 8 1.633334 $55.9000 $34.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.211111 $1055.5000 $4999.7400
AUD -HA_FUP AUDIOLOGY SERVICES 3 4 3.555556 $177.7800 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1640 2260 4108.823809 $205441.1800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1641 2241 4051.963488 $202598.1500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1638 2231 3997.726190 $199886.3000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1637 2260 4019.474226 $200973.6800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 273 365 2304.573036 $115228.4900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 30 189.443651 $12859.4200 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 16 22 165.280950 $11219.2700 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 0.205556 $102.8000 $500.1100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.049315 $3.2000 $64.9800
SENS -V5264 EARMOLD 2 2 0.511111 $9.2000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 10 16 13.520635 $676.0400 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 41 51 330.834924 $22457.0500 $67.8800
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Subtotal (Total Children Is Unduplicated) 1646 9485 19186.173558 $972688.0500 $50.7000
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Total 9497 19193.492606 $972743.9600 $50.6800
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Number of Children (Unduplicated) With at Least One Authorization 1648