Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 3772 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 1.000000 $37.0000 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 3 3 1.400000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 13 14 45.341269 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 18 47.741269 $37.0000 $0.7800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 1.327778 $64.4000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.227778 $10.7300 $47.0900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.172222 $3.3100 $19.2000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 120 126 91.490475 $2008.2100 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 14.087301 $123.2600 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.511111 $11.1600 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $65.1400 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.366667 $9.3600 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 8 6.299999 $294.8400 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 11 8.366666 $1000.6500 $119.6000
EXIT -EXIT EXIT ASSESSMENT 7 7 126.238096 $6311.9100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.227778 $17.0900 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 28 47 30.766665 $2307.4900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 59 100 68.356770 $5126.7300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.216667 $16.2500 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 20 27 22.092062 $1656.8900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 75 128 104.007566 $5772.4100 $55.5000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 3.000000 $225.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 18 18 24.961904 $1385.3900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 4.511111 $338.3300 $75.0000
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Subtotal (Total Children Is Unduplicated) 229 489 508.228616 $26748.5400 $52.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 16 10.127777 $50638.5000 $4999.9600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.244444 $62.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 25 25 21.654762 $1082.7400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.538889 $38.5900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 38 39 20.946033 $5010.3100 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 46 57 142.904764 $7145.2500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 3.309524 $82.7400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 300 432 633.032537 $31651.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 24 33 26.911108 $672.7700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 5.533334 $276.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 3.133334 $156.6700 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 17 23 66.738889 $4893.3000 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 21 26 102.436505 $2560.9100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 837 1095 7019.733329 $350986.7300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 836 1486 7750.334123 $77503.3600 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.255555 $81.6100 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.488889 $353.0500 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 5 5 4.277777 $2028.6600 $474.2300
SENS -V5264 EARMOLD 8 8 7.044443 $126.8000 $18.0000
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Subtotal (Total Children Is Unduplicated) 848 3265 15822.646016 $535352.4800 $33.8300
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Total 3772 16378.615901 $562138.0200 $34.3200
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Number of Children (Unduplicated) With at Least One Authorization 850