Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 4809 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 97 106 138.814779 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 3.555556 $131.5600 $37.0000
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Subtotal (Total Children Is Unduplicated) 99 108 142.370335 $131.5600 $0.9200
Screening, Eval, and Assessment, Class # 02
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.000000 $8.7500 $8.7500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.066667 $3.1200 $46.8200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 3.000000 $358.8000 $119.6000
EXIT -EXIT EXIT ASSESSMENT 18 18 36.000000 $1800.0000 $50.0000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 2.000000 $102.1000 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.252055 $3.9300 $15.6000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 23 25 44.318722 $2378.8000 $53.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.060274 $10301.5000 $5000.0600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 8 12 6.933334 $346.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 39 45 59.317461 $2965.8800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 12 12 5.600001 $1339.5900 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 197 217 50.855179 $2542.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 21 22 0.651356 $16.3000 $25.0200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 49 54 85.188890 $4259.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 15 16 16.749998 $418.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 21 24 41.050000 $2052.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 10 10 15.633332 $390.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 22 26 38.366666 $1918.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 8 8 8.716666 $217.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 37 44 66.470397 $3323.5300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 11 12.833332 $320.8300 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 25.142857 $628.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 116 149 4286.500002 $107162.4800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 783 1001 7661.584909 $383079.4900 $50.0000
INTR -T1013 INTERPRETER 43 48 318.728569 $15936.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1176 1861 13730.160621 $137301.7100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 157 224 975.421433 $69684.1400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 21 28 128.750000 $7364.5100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 192 257 1167.021438 $83371.8900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 36 42 193.724999 $11073.3200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 14 14 2.471234 $160.6500 $65.0100
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.252055 $29.8900 $118.5800
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 4.000000 $948.4800 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
2 2 0.331507 $78.6300 $237.1900
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 11 11 4.520549 $2143.9400 $474.2700
SENS -V5264 EARMOLD 37 46 57.303171 $1031.4500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 351 468 2236.478583 $159774.0900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 13 16 215.785715 $2995.1000 $13.8800
TRAV -TRAVS Travel by mile 1 1 1.900000 $0.8500 $0.4500
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Subtotal (Total Children Is Unduplicated) 1324 4676 31420.504528 $1013180.6300 $32.2500
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Total 4809 31607.193585 $1015690.9900 $32.1300
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Number of Children (Unduplicated) With at Least One Authorization 1401