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: 04-01-17 and 06-30-17 Date of Report: 08-05-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3985 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 6 6 1.933332 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 9 26.180952 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 15 28.114284 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 2.505556 $121.5200 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.294444 $6.2900 $21.3500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 115 118 74.123822 $1597.3900 $21.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.127778 $2.6400 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 2.888890 $130.0100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 3.550381 $408.3000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 9 10 11.027778 $551.3900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 3 0.511112 $38.3400 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 24 43 79.650004 $5973.7800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 71 139 89.094457 $6682.1800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 7 3.844444 $288.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 40 69 41.932543 $3144.9600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 88 163 104.787314 $5815.7600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 11 12 161.285714 $8951.3600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 5.000000 $375.0000 $75.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.505556 $7.5800 $15.0000
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Subtotal (Total Children Is Unduplicated) 216 587 585.129793 $34394.8200 $58.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 13 6.444446 $32223.0000 $5000.1200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.505556 $25.2800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 7 11.181746 $559.0900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 47 51 21.183344 $4872.4100 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 63 76 169.984128 $8499.2200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 302 471 526.226907 $26311.4600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 15 15 13.003967 $325.1000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 2.727778 $136.3900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 1.433334 $71.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.033333 $75.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 4.100000 $205.0000 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 21 25 66.180951 $4852.3900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 29 35 169.571431 $4239.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 838 1112 6728.546069 $336427.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 842 1532 7293.355511 $72933.5900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 5.371429 $383.7300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 8.028572 $459.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2 2 3.238096 $231.3300 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.122222 $7.9400 $64.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.383714 $315.4800 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
2 2 1.011112 $230.5500 $228.0200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
3 3 1.538889 $701.7400 $456.0000
SENS -V5264 EARMOLD 7 7 7.972222 $143.5000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 7 10.133333 $723.9200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 1.666667 $23.1300 $13.8800
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Subtotal (Total Children Is Unduplicated) 851 3383 15058.944757 $495002.6600 $32.8700
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Total 3985 15672.188834 $529397.4800 $33.7800
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Number of Children (Unduplicated) With at Least One Authorization 858