Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 11683 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 97 106 470.726982 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 5 17.574169 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 7 7 4.066667 $150.4700 $37.0000
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Subtotal (Total Children Is Unduplicated) 105 118 492.367818 $150.4700 $0.3100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 39 47 79.603057 $3860.7600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.077321 $97.8200 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 12 14 11.551589 $172.4700 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 12 15 12.551589 $240.9900 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 12 15 12.551589 $130.7900 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 11 12 5.313493 $116.6300 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 12 14 11.551589 $101.0800 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 12 14 11.551589 $93.1100 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 13 15 11.929367 $260.5400 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 12 14 11.551589 $333.8400 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 10 3.413493 $222.3600 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 13 15 11.740478 $299.7400 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 6 2.918722 $136.6000 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.285235 $153.7100 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 3.000000 $150.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 142 146 290.066667 $14503.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 25 25 40.513698 $3038.5300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 7.000000 $525.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 14.077778 $1055.8400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 20 20 33.005479 $2475.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 19 27.010959 $1499.1000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 254 259 551.701366 $41377.6100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 86 86 170.578082 $12793.3600 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 80 80 130.013700 $9751.0200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 330 331 678.489137 $37656.1400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 124 145 211.137282 $15835.2800 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 3.285714 $164.2900 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 2.000000 $102.1000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 9 10 22.844227 $1166.2000 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 3.000000 $153.1500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 28 29 194.013146 $9904.3800 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 4 7.466666 $116.4800 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 33 34 125.753697 $6419.7300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 717 1407 2709.548298 $165236.5900 $60.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 35 40 78.469343 $392347.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 3.466667 $173.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 36 38 498.463848 $24923.1800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 4.142857 $296.6700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 3 5 2.306850 $551.8100 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 222 249 278.088071 $13904.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 5.452778 $136.3200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 249 395 1014.274711 $50713.8200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 4 4.000001 $100.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 47 57 240.103970 $12005.2000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.566667 $14.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 98 118 307.940304 $15397.0800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 146 169 384.966675 $19248.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 22.961905 $574.0500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1507 1917 15263.176380 $763159.4900 $50.0000
INTR -T1013 INTERPRETER 91 113 577.769960 $28888.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1703 3066 20801.699448 $208017.1500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 61 81 659.019177 $47080.3700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 16.419048 $939.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 168 218 1652.620641 $118063.2900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 9 9 68.222223 $3899.5900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 7 4.804870 $312.3100 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 5 3.663013 $434.2900 $118.5600
SENS -V5060 BEHIND EAR HEARING AID
3 3 2.131507 $505.4200 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 3 1.252055 $593.8000 $474.2600
SENS -V5264 EARMOLD 14 19 19.027855 $342.5000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 254 338 2433.194775 $173827.5700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.714286 $155.2600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 4.712699 $65.4100 $13.8800
TRAV -TRAVS Travel by mile 1745 3281 72076.753058 $32074.1700 $0.4500
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Subtotal (Total Children Is Unduplicated) 1782 10158 116432.385642 $1908743.6800 $16.3900
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Total 11683 119634.301758 $2074130.7300 $17.3400
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Number of Children (Unduplicated) With at Least One Authorization 1922