Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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 6532 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 7 7 7.899999 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 7 7 7.899999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 79 104 30.872677 $1497.4000 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.115068 $1.7200 $14.9300
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 2.625113 $27.3500 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 13 13 2.700153 $59.2800 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 2.548401 $22.3000 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 2.548401 $55.6600 $21.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 0.101370 $3.8900 $38.3800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 0.367123 $8.4100 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 2.433333 $62.1200 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 16.286236 $762.2000 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 13.723679 $1641.3500 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 6 6 3.761643 $188.0800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 99 101 67.127247 $3356.3800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 8 8 2.036984 $152.7800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.016437 $1.2400 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 4.020547 $223.1400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 131 132 112.050659 $8403.8900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 16.079447 $1205.9800 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 144 146 142.407606 $7903.6900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 43 44 38.145201 $2860.9100 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 14 17 3.473137 $177.3100 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 52 58 19.092700 $974.6800 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 16 22 15.080032 $769.8400 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 80 86 31.813493 $1624.1000 $51.0500
SCREEN-T1023 SCREENING 16 23 6.779073 $338.9600 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.287671 $14.6900 $51.0600
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 0.413699 $21.1200 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 52 57 16.665908 $850.8100 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 460 881 553.573038 $33209.2800 $59.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 83 114 36.556010 $182788.0000 $5000.2200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 2.589497 $129.4800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.076712 $18.3500 $239.1600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 82 100 49.842255 $2492.1000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 15 18.975284 $474.3800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 423 602 1315.137684 $65757.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 16 22 63.271430 $1581.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 109 151 312.285708 $15614.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 7 15.433334 $385.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 78 95 212.082620 $10604.1800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 6.944445 $173.6100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 323 390 840.299668 $42015.2000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 11 13 28.994447 $724.8700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 47 51 2372.633339 $59315.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 494 630 5009.510633 $250475.7000 $50.0000
INTR -T1013 INTERPRETER 16 23 120.742205 $6037.1100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 590 1153 6356.884930 $63568.9100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 148 190 1807.703230 $129142.4000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 188 238 2216.521391 $158348.4500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 27.571428 $1575.9900 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.504110 $119.5300 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 3 13.219569 $6269.2600 $474.2400
SENS -V5264 EARMOLD 4 5 15.384257 $276.9200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 191 233 2205.027720 $157527.2900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 13.356556 $185.3900 $13.8800
TRAV -TRAVS Travel by mile 673 1595 389587.909374 $173366.6300 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 739 5644 412649.457836 $1328968.7100 $3.2200
-------------------------------------------------------------------------------------------------------------------------------------
Total 6532 413210.930873 $1362177.9800 $3.3000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 750