Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 12603 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 79 90 162.877778 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 5 3.000001 $111.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 83 95 165.877779 $111.0000 $0.6700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 62 69 122.517788 $5942.1200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 4.355555 $223.6500 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 7 3.136834 $56.2100 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 7 3.966667 $84.6900 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 9 3.784323 $47.7200 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 11 16 10.039878 $216.3600 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 7 4.147489 $34.2600 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 3 1.377778 $12.4800 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 6 2.147489 $54.3500 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 5 1.966667 $68.7800 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 3.388889 $261.3900 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 3 1.252055 $58.1200 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 5 1.021766 $18.9500 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 10 7.784932 $160.9900 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 11 7.749314 $348.7200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 10 7.043683 $810.0300 $115.0000
EXIT -EXIT EXIT ASSESSMENT 187 190 380.000000 $19000.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 26 26 25.086756 $1881.5100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.066667 $155.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 6.005480 $450.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 19 20 19.571688 $1467.8800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 21 21 25.594064 $1420.4700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 287 289 465.790994 $34934.3300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 45 45 95.285714 $7146.4300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 66 66 104.222505 $7816.6900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 375 378 651.425632 $36154.1300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 133 134 230.505480 $17287.9100 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 10 10 13.000000 $663.6500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 6.331508 $323.2200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 7 7.139727 $364.4800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 6.000000 $306.3000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 6.661796 $340.0800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 1.295890 $66.1600 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 7 11 5.436985 $81.5500 $15.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 18 20 89.850837 $4586.8900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 3.200000 $163.3600 $51.0500
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Subtotal (Total Children Is Unduplicated) 773 1425 2330.152830 $143009.2600 $61.3700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 56 66 124.183053 $620915.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 5 3.626331 $181.3200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 49 53 72.924828 $3646.2300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 13.580952 $972.5300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 10 13 12.171536 $2799.4500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 284 319 346.583903 $17329.1800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 2.500000 $62.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 235 325 703.176477 $35158.9000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 56.566667 $1414.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 54 68 145.630957 $7281.5700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 14.342857 $358.5700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 136 164 319.680173 $15984.0700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 6.933333 $173.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 178 231 432.597196 $21629.9100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 50.919048 $1272.9800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 3.714286 $92.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1570 1996 15709.101368 $785455.6500 $50.0000
INTR -T1013 INTERPRETER 146 197 798.973808 $39948.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1834 3268 22552.474656 $225524.9000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 70 89 626.760315 $44775.7800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 20.714286 $1184.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 182 247 1681.938099 $120157.7300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 27.539683 $1574.1600 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 8 5.920471 $384.8300 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 7 4.580669 $522.1900 $114.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
5 8 5.226331 $2383.1900 $456.0000
SENS -V5264 EARMOLD 16 23 23.829528 $428.9300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 300 392 3152.138097 $225188.8800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 18.142858 $1037.7700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 16 16 128.357144 $1781.6000 $13.8800
TRAV -TRAVS Travel by mile 1892 3555 48873.705543 $21748.8200 $0.4500
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Subtotal (Total Children Is Unduplicated) 1926 11083 95939.534453 $2201371.0500 $22.9500
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Total 12603 98435.565062 $2344491.3100 $23.8200
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Number of Children (Unduplicated) With at Least One Authorization 2013