Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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 6946 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 2 2 6.890476 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 6.890476 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 92 115 45.091796 $2187.0000 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.430137 $7.7100 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.252055 $26.7300 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 8 8 5.701066 $71.8900 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 7 2.352207 $50.6900 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 5 4.940640 $40.8100 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 4.496804 $113.8100 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.133333 $10.2800 $77.1100
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 13.586693 $630.6900 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.430137 $7.9800 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 4.066667 $84.1000 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 13.331899 $599.9300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 13.542858 $1557.4200 $115.0000
EXIT -EXIT EXIT ASSESSMENT 131 131 192.642598 $9632.1400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 2.016437 $151.2400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 8.350684 $463.4600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 105 105 91.847925 $6888.6700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 60 60 68.639716 $5148.0200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 120 120 116.821895 $6483.6700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 71 71 81.653415 $6124.0400 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.208219 $10.6300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 15 16 6.601371 $337.0000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 25 28 6.246043 $318.8800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 40 46 10.229528 $522.2400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 13 17 15.709982 $802.0100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 16 18 8.332497 $425.3800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 17 18 4.770470 $243.5400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 44 52 20.126209 $1027.4700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 2.446805 $124.9100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 7 11 2.569255 $131.1600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 84 92 31.996658 $1633.4700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 22 23 5.365982 $273.9500 $51.0500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.186301 $6.7000 $35.9800
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.186301 $9.3200 $50.0000
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Subtotal (Total Children Is Unduplicated) 503 991 792.310062 $46597.3600 $58.8100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 95 120 50.895828 $254483.5000 $5000.0900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 3.066667 $153.3400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 0.756165 $173.9300 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 76 80 62.486101 $3124.3200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 2.344444 $58.6100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 494 665 1404.414342 $70221.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 9 12.150000 $303.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 195 241 475.242882 $23762.2700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.533333 $88.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 70 83 170.583342 $8529.2100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.866667 $21.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 377 463 922.150040 $46107.7000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 8.916667 $222.9200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 25 26 850.714290 $21267.8500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 560 699 5592.853997 $279642.9300 $50.0000
INTR -T1013 INTERPRETER 30 49 71.052760 $3552.6500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 587 1071 5943.330305 $59433.3800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 153 189 1599.869052 $114294.7100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 54.642856 $3125.5700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 154 189 1589.555903 $113557.9500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 3 12.495238 $714.2300 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 0.504110 $114.9300 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.673973 $153.6700 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
3 4 13.356556 $6090.5600 $456.0000
SENS -V5264 EARMOLD 6 9 17.255796 $310.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 185 227 1876.642859 $134067.4400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.428571 $196.1200 $57.2000
TRAV -TRAVS Travel by mile 715 1804 457656.396525 $203657.1000 $0.4500
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Subtotal (Total Children Is Unduplicated) 782 5953 478400.179269 $1347430.2200 $2.8200
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Total 6946 479199.379807 $1394027.5800 $2.9100
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Number of Children (Unduplicated) With at Least One Authorization 789