Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 3574 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 10 10 232.224605 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 10 232.224605 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 3.200000 $150.6900 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 8 8 9.000000 $134.3700 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 8 8 9.000000 $172.8000 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 8 8 9.000000 $93.7800 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 16 16 10.583562 $232.3100 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 33 33 12.013699 $105.1300 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 5 5 5.000000 $40.3000 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 32 32 11.613699 $253.6600 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 5.000000 $144.5000 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 4.000000 $260.5600 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 4.000000 $153.4800 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 29 29 9.427398 $215.9000 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 4.000000 $102.1200 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 3.738812 $174.9800 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.933333 $231.2200 $119.6000
EXIT -EXIT EXIT ASSESSMENT 51 51 22.920702 $1146.0300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.068493 $5.1400 $75.0100
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 2.071233 $114.9500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 38 38 44.087664 $3306.6000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 6 6 2.238356 $167.8700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 48 48 39.115067 $2170.8900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 20 20 2.739727 $205.4800 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 1.000000 $51.0500 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 10 10 5.075190 $259.0900 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.655555 $33.4600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 6 1.828311 $93.3300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 48 49 66.608913 $3400.3600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 14 15 7.850000 $400.7400 $51.0500
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Subtotal (Total Children Is Unduplicated) 229 421 304.775193 $14226.4500 $46.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.098630 $5493.0000 $4999.8600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 1.488889 $74.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 35 35 31.789609 $1589.4900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 4.477778 $1071.0900 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 166 205 259.941710 $12997.1400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 6 8.611111 $215.2800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 378 759 2486.549701 $124327.7400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 16 32 92.285718 $2307.1500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 26 120.214290 $6010.7400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 6.133334 $153.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 12 42.390478 $2119.5400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 33 36 164.319050 $8215.9600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 6 14.752381 $368.8100 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 13.142857 $657.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1229 1674 14519.568735 $725978.8800 $50.0000
INTR -T1013 INTERPRETER 14 15 149.857142 $7492.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 2 12.571428 $125.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 23 26 219.571428 $15686.2000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 26 36 281.147618 $20085.1900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 21.714286 $1241.1900 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $474.2400 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 3 3 3.511111 $1665.1000 $474.2400
SENS -V5264 EARMOLD 4 4 13.100000 $235.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 120 148 1220.457143 $87189.5300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 33.428572 $463.9900 $13.8800
TRAV -TRAVS Travel by mile 65 98 744.052377 $331.1000 $0.4500
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Subtotal (Total Children Is Unduplicated) 1270 3143 20468.175376 $1026570.6500 $50.1500
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Total 3574 21005.175174 $1040797.1000 $49.5500
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Number of Children (Unduplicated) With at Least One Authorization 1296