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: 10-01-13 and 12-31-13 Date of Report: 02-18-14 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
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 1 1 0.400000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.400000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.866667 $12.4500 $14.3600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 8 12 4.461111 $82.3500 $18.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 8 12 4.461111 $44.7000 $10.0200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 13 5.438889 $45.7400 $8.4100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 9 13 5.438889 $114.2200 $21.0000
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 4 1.299999 $28.6200 $22.0200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.433333 $10.6400 $24.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 1.044443 $46.9900 $44.9900
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 0.722221 $83.0400 $114.9800
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Subtotal (Total Children Is Unduplicated) 9 63 24.166663 $468.7500 $19.4000
EI Services, Class # 03
AUD -HA_FUP AUDIOLOGY SERVICES 8 12 7.933333 $396.6700 $50.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1613 3424 5329.054056 $266453.1300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1612 3402 5303.820733 $265191.5300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1614 3391 5305.464380 $265273.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1613 3436 5355.955645 $267798.2300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 978 1361 8917.738052 $445887.3700 $50.0000
INTR -INTR INTERPRETER 1 1 6.285714 $314.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 228 324 2003.962687 $136029.1400 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 349 494 3274.589666 $222279.4400 $67.8800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 1 1 0.044444 $22.2000 $499.5000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 0.255556 $29.1400 $114.0200
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 2 2 0.677777 $154.5200 $227.9700
SENS -V5264 EARMOLD 8 12 5.250000 $94.5000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 26 38 32.809522 $1640.4700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 661 928 5861.362675 $397869.6900 $67.8800
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 551 2019 259649.180953 $129824.5900 $0.5000
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Subtotal (Total Children Is Unduplicated) 1619 18846 301054.385193 $2399258.5600 $7.9700
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Total 18910 301078.951856 $2399727.3100 $7.9700
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Number of Children (Unduplicated) With at Least One Authorization 1619