Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 5339 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 97 106 169.391273 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 97 106 169.391273 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.252055 $11.3400 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 2.397260 $275.6900 $115.0000
EXIT -EXIT EXIT ASSESSMENT 28 28 56.000000 $2800.0000 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 3.000000 $153.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 38 39 65.649315 $3408.3300 $51.9200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 8 8.522222 $426.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 35 46 50.344447 $2517.2400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 7 8 4.008219 $921.9300 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 195 211 19.756702 $988.1300 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 14 15 1.718058 $42.9600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 62 73 101.555557 $5077.7900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 22 26 26.166665 $654.1600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 29 40.755557 $2037.7900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 12 14 13.666665 $341.6600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 26 40.124999 $2006.2500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 13 14 16.733332 $418.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 46 57 84.109921 $4205.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 22 23 26.099997 $652.4900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 2 52.571428 $1314.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 101 124 3633.857147 $90846.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 989 1265 9636.914266 $481846.2600 $50.0000
INTR -T1013 INTERPRETER 22 26 127.754250 $6387.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1388 2133 16406.951572 $164069.7000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 180 240 1193.638109 $85273.5000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 21 23 143.369047 $8200.7200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 192 248 1212.561923 $86625.3100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 7 35.228572 $2013.6700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 12 4.661188 $302.9900 $65.0000
SENS -V5060 BEHIND EAR HEARING AID
3 3 1.397260 $318.5800 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
8 9 5.008219 $2283.8300 $456.0200
SENS -V5264 EARMOLD 33 44 45.177778 $813.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 370 483 2618.939311 $187096.8900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 21 23 413.571431 $5740.3700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1514 5194 35967.163842 $1153423.7500 $32.0700
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Total 5339 36202.204430 $1156832.0900 $31.9500
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Number of Children (Unduplicated) With at Least One Authorization 1585