Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 3373 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 3 3 5.433333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 7.693651 $284.6600 $37.0000
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Subtotal (Total Children Is Unduplicated) 6 6 13.126984 $284.6600 $21.6900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.744444 $36.1000 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 4.300000 $44.8100 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 4.300000 $37.6300 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 4.300000 $93.9100 $21.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $22.9000 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 2.466667 $62.9700 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.202740 $9.4900 $46.7900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.202740 $24.2400 $119.5800
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 3.000000 $375.0000 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 2 2 3.000000 $375.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 4 4 5.368254 $268.4100 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.344444 $17.5800 $51.0400
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 37 38 39.558599 $2019.4800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 14 14 11.233181 $573.4500 $51.0500
SCREEN-T1023 SCREENING 69 69 52.301850 $2615.1000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 9 9 8.082192 $412.6000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 33 33 26.222221 $1338.6400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 5 5 5.000000 $255.2500 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 164 199 174.627332 $8733.6000 $50.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 3.000000 $15000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 4.766667 $238.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 21 24 47.741631 $2387.0900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.066667 $26.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 409 642 1543.622831 $77181.1300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.533333 $13.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 277 405 1060.172153 $53008.6400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 160 215 606.344438 $30317.1900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 374 475 1254.088096 $62704.4100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 7.966666 $199.1700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 6 15.395825 $769.8000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 379 515 3289.204161 $164460.2800 $50.0000
INTR -T1013 INTERPRETER 2 2 30.057143 $1502.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 135 194 983.575792 $70266.7100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 28 44 221.357143 $12661.6300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 118 161 878.922616 $62790.2700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 9 12 111.995240 $6401.6500 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $237.1200 $237.1200
SENS -V5264 EARMOLD 3 3 2.355555 $42.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 343 448 2985.604768 $213291.6400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 46.342857 $643.2400 $13.8800
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Subtotal (Total Children Is Unduplicated) 760 3168 13095.113582 $774143.5400 $59.1200
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Total 3373 13282.867898 $783161.8000 $58.9600
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Number of Children (Unduplicated) With at Least One Authorization 767