Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 07-01-16 and 09-30-16 Date of Report: 10-26-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3990 FSPSA's found
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 2 2 0.266667 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 12 13 66.911905 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 14 15 67.178572 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.705555 $33.2200 $47.0900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.511111 $9.8100 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.744444 $7.7600 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 89 90 56.142061 $1232.3100 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 12.243651 $107.1300 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.161111 $3.5200 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 0.072222 $4.7000 $65.1200
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 14 6.400000 $299.5200 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 11 15 5.577776 $667.0800 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.677778 $133.8900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 8 8 6.972222 $348.6100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 1.983333 $148.7500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 19 28 24.411109 $1830.8200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 55 80 71.620847 $5371.5200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 1.072223 $80.4200 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 33 42 27.561110 $2067.0800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 78 118 93.231953 $5174.3200 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 31 31 56.522222 $3136.9800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 16 16 29.000000 $2175.0000 $75.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 229 462 398.610728 $22880.9400 $57.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 21 9.364382 $46821.0000 $4999.9000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 1.538888 $76.9400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 60 62 41.709032 $2085.4300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 7.243651 $518.7100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 22 22 15.471429 $3700.7600 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 62 67 320.873812 $16043.7000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 3.022222 $75.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 330 498 764.146820 $38207.3200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 33 46 54.955552 $1373.8800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 21 26 93.657936 $6867.0000 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 25 28 112.963491 $2824.0900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 811 1119 6974.546802 $348727.5800 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 814 1588 7815.051562 $78150.5600 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 4 1.844444 $119.8900 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 3 5 2.666666 $632.3000 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 3 3 1.527778 $724.5400 $474.2500
SENS -V5264 EARMOLD 9 12 6.477776 $116.6000 $18.0000
TRAV -TRAVS Travel by mile 1 1 3.642857 $1.6200 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 826 3513 16232.705100 $547167.4700 $33.7100
-------------------------------------------------------------------------------------------------------------------------------------
Total 3990 16698.494400 $570048.4100 $34.1400
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 828