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 8912 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 72 83 159.004762 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 1.377778 $50.9800 $37.0000
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Subtotal (Total Children Is Unduplicated) 74 85 160.382540 $50.9800 $0.3200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 57 63 119.395718 $5790.7000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $51.3500 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.147945 $2.6500 $17.9100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 0.328767 $4.1400 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.147945 $3.1900 $21.5400
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.180822 $1.4900 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.180822 $4.5800 $25.3100
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.147945 $6.8700 $46.4100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.328767 $6.1000 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.180822 $3.7400 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.266667 $12.0000 $45.0100
EXIT -EXIT EXIT ASSESSMENT 187 190 380.000000 $19000.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 4.010958 $300.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 20.016437 $1501.2400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 6.500000 $487.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 32 32 54.516437 $3025.6700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 14 14 26.000000 $1950.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 1.084932 $55.3800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 2.120548 $108.2500 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.533333 $8.0000 $15.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $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) 276 352 635.094344 $33467.4300 $52.7000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 13 7.244749 $36223.5000 $4999.9700
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 35 36 43.225624 $2161.2800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.511111 $36.6000 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 281 316 341.917236 $17095.8500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 2.500000 $62.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 233 318 683.762190 $34188.1800 $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 134 161 313.846839 $15692.4000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 6.933333 $173.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 175 228 426.163862 $21308.2400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 50.919048 $1272.9800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 145 167 1244.328577 $62216.5200 $50.0000
INTR -T1013 INTERPRETER 141 190 755.902379 $37795.1400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1833 3265 22544.922275 $225449.3700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 18 110.552381 $7897.8600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 34 36 279.558731 $19971.7000 $71.4400
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.847641 $55.1000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.533333 $60.8000 $113.9900
SENS -V5264 EARMOLD 2 3 1.380974 $24.8600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 68 76 756.461905 $54041.7100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 10.571429 $604.6800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 50.571428 $701.9300 $13.8800
TRAV -TRAVS Travel by mile 1891 3552 48866.153162 $21745.4600 $0.4500
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Subtotal (Total Children Is Unduplicated) 1913 8475 76716.348688 $567834.2800 $7.4000
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Total 8912 77511.825572 $601352.6900 $7.7600
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Number of Children (Unduplicated) With at Least One Authorization 1954