Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3934 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 17 21 38.895238 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 21 38.895238 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.722222 $12.9400 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 5 3.811111 $81.3700 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 5 1.700000 $21.4400 $12.6100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 5 3.811111 $31.4800 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 5 3.811111 $96.4600 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 4 1.277778 $98.5600 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 5 3.811111 $70.7000 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 3 2.950000 $61.0100 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 0.661111 $29.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.238889 $27.4700 $115.0100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 2.933333 $146.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 43 54 190.699199 $9534.9800 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.500000 $76.5800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 53 99 218.926976 $10340.4400 $47.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 1.144444 $57.2200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 208 257 199.875037 $9993.8000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 79 83 39.573051 $989.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 136 146 307.529224 $15376.4600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.500000 $37.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 74 78 211.598420 $10579.9000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 94 101 201.691355 $10084.5600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 138 149 307.251580 $15362.5900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 9 20.238095 $505.9500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 4 10.142857 $253.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1304 1665 12125.676217 $606283.3800 $50.0000
INTR -T1013 INTERPRETER 2 2 11.428571 $571.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 183 241 1771.052397 $126523.8800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.285714 $302.3400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 247 356 2527.341997 $180553.2200 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.178082 $11.5800 $65.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.238889 $54.4700 $228.0100
SENS -V5264 EARMOLD 4 5 1.461111 $26.3000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 507 705 5281.585722 $377316.1400 $71.4400
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Subtotal (Total Children Is Unduplicated) 1794 3814 23028.792763 $1359958.6200 $59.0500
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Total 3934 23286.614977 $1370299.0500 $58.8400
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Number of Children (Unduplicated) With at Least One Authorization 1803