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 8219 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 93 102 465.860315 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 5 17.574169 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 94 107 483.434484 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 34 42 77.547501 $3761.0700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.077321 $97.8200 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.624603 $24.2600 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 2.624603 $50.3900 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 2.624603 $27.3500 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.624603 $35.6600 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.624603 $14.2200 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 1.624603 $13.0900 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.624603 $35.4800 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.624603 $46.9500 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 1.624603 $105.8300 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 1.813492 $46.3000 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.252055 $11.8000 $46.8100
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 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 2.002740 $111.1500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 35 35 59.500000 $4462.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 12 12 19.000000 $1425.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 15 15 27.500000 $2062.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 62 62 101.802152 $5650.0200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 14 15 23.505479 $1762.9100 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 3.285714 $164.2900 $50.0000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1 1 2.000000 $102.1000 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 2.000000 $102.1000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 4 4 9.976985 $509.3300 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 5.400000 $84.2400 $15.6000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 4.433943 $226.3600 $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) 274 377 661.790955 $36288.5400 $54.8300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 14 7.561339 $37807.0000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.566667 $78.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 26 27 483.708728 $24185.4300 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 3 0.306850 $73.4100 $239.2400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 215 242 270.077113 $13503.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 5.450000 $136.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 243 379 959.750901 $47987.6400 $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 95 115 302.706970 $15135.4100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 144 167 377.833342 $18891.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 22.961905 $574.0500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 172 202 1540.174599 $77008.7900 $50.0000
INTR -T1013 INTERPRETER 90 112 575.769960 $28788.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1692 3031 20539.474788 $205394.9000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 14 137.561904 $9827.4300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 26 31 306.819046 $21919.1900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 19.000000 $1086.0400 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 4.044444 $262.8900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 2.000000 $237.1200 $118.5600
SENS -V5060 BEHIND EAR HEARING AID
1 1 2.000000 $474.2400 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 1 2 0.252055 $119.5600 $474.3200
SENS -V5264 EARMOLD 4 5 7.433333 $133.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 64 73 581.123809 $41515.5300 $71.4400
TRAV -TRAVS Travel by mile 1736 3237 68961.696174 $30687.9700 $0.4500
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Subtotal (Total Children Is Unduplicated) 1760 7735 95353.944565 $587948.3700 $6.1700
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Total 8219 96499.170004 $624236.9200 $6.4700
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Number of Children (Unduplicated) With at Least One Authorization 1842