Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 8187 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 35 38 25.833331 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 35 38 25.833331 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 5 3.905555 $58.3100 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 852 899 568.738096 $10919.7700 $19.2000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.416667 $15.9900 $38.3700
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 7 5.011111 $234.5200 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 7 5.011111 $599.3300 $119.6000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 75 78 66.866666 $3413.5400 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 19 22 17.333333 $884.8600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 128 139 146.907934 $7499.6400 $51.0500
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Subtotal (Total Children Is Unduplicated) 979 1158 814.190473 $23625.9600 $29.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 1.322223 $6611.5000 $5000.2900
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 2.988889 $714.9400 $239.2000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1041 1381 758.071396 $37903.4100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 166 199 155.816659 $7790.8000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 270 327 262.630530 $13131.4000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 726 894 660.124573 $33006.0900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1550 2333 19442.409885 $972120.7800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 374 484 2973.437321 $212422.3900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.142857 $294.1700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 481 622 3376.822651 $241240.1100 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 7 8 6.511111 $1543.9100 $237.1200
SENS -V5264 EARMOLD 7 8 6.511111 $117.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 565 724 4374.603207 $312521.7200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 16.500000 $229.0200 $13.8800
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Subtotal (Total Children Is Unduplicated) 2020 6991 32042.892413 $1839647.4300 $57.4100
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Total 8187 32882.916217 $1863273.3900 $56.6600
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Number of Children (Unduplicated) With at Least One Authorization 2058