Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 4176 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 44 53 853.619841 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 44 53 853.619841 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.406241 $20.8600 $51.3600
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 5 3.888890 $69.6900 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 16 17 15.888890 $339.2300 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 7 5.888890 $74.2600 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 26 27 31.283411 $674.1600 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 60 62 38.230278 $315.7800 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 60 61 33.599075 $850.3900 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 18 19 17.080671 $597.3200 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 4.825115 $372.1700 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 4.633334 $215.0800 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 43 44 19.019167 $352.8100 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 19 20 21.500001 $444.6200 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 2.745281 $123.5400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 2.232420 $256.7400 $115.0000
EXIT -EXIT EXIT ASSESSMENT 112 112 86.042390 $4302.1400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 10.568298 $792.6200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 0.139727 $7.7500 $55.4900
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 15 25.010958 $1875.8300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 34 34 13.202737 $732.7700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 26 27 3.191779 $239.4100 $75.0100
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 1.563090 $79.8000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 4.061111 $207.3200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 25 25 11.085007 $565.8900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 1.511111 $77.1400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 7 6.005556 $306.5900 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 40.094444 $2046.8200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 5.087671 $259.7300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 72 74 45.925952 $2344.5200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 31 31 16.455554 $840.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 335 632 476.167049 $19688.1600 $41.3500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 4.511111 $22555.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 3.522223 $176.1200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 44 45 54.940663 $2747.0400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.305556 $93.4900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 3.566667 $820.3400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 169 194 185.107650 $9255.3600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 1.938890 $48.4800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 424 850 2620.692249 $131034.7700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 6 8.333334 $208.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 20 31 124.290479 $6214.5400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 9.857143 $246.4300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 14 46.480954 $2324.0600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.866667 $21.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 63 77 358.723810 $17936.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 6 8.800001 $220.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 12.857143 $321.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1266 1721 14658.085701 $732904.8500 $50.0000
INTR -T1013 INTERPRETER 12 17 156.752381 $7837.6300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 62 504.857142 $36067.0200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 28.142858 $1609.7700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 48 64 543.530954 $38829.8800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 7.000000 $400.1200 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.065753 $15.0000 $228.1600
SENS -V5060 BEHIND EAR HEARING AID
1 1 1.166667 $266.0100 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 1 0.800000 $364.8000 $456.0000
SENS -V5264 EARMOLD 5 5 7.164841 $128.9700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 225 280 2383.695238 $170291.3400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.714286 $212.4600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 12 12 100.285713 $1391.9700 $13.8800
TRAV -TRAVS Travel by mile 54 76 656.838097 $292.2900 $0.4500
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Subtotal (Total Children Is Unduplicated) 1367 3491 22497.894171 $1184835.8600 $52.6600
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Total 4176 23827.681061 $1204524.0300 $50.5500
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Number of Children (Unduplicated) With at Least One Authorization 1412