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 3190 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 94 103 133.003668 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 94 103 133.003668 $0.0000 $0.0000
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
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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 21 21 39.066667 $1913.9700 $48.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.060274 $10301.5000 $5000.0600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.355556 $17.7800 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 9 12 15.333335 $766.6800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.331507 $318.5200 $239.2200
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 246 315 2453.695227 $122684.9000 $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 48 65 270.216670 $19304.2800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 8 11 47.778571 $2732.9400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 68 88 418.083334 $29867.8400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 11 58.078571 $3319.7700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 7 1.060274 $68.9300 $65.0100
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.079452 $18.8500 $237.2600
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 1.128767 $535.3200 $474.2500
SENS -V5264 EARMOLD 6 8 5.499999 $99.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 146 185 961.530959 $68691.8100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 200.000000 $2776.0000 $13.8800
TRAV -TRAVS Travel by mile 1 1 1.900000 $0.8500 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1215 3066 18823.537502 $430204.4600 $22.8500
-------------------------------------------------------------------------------------------------------------------------------------
Total 3190 18995.607837 $432118.4300 $22.7500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1293