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 2120 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
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.866667 $15.5300 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 2.866667 $61.2000 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.866667 $23.5400 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 2.058448 $44.3600 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 10 11 8.326332 $68.7800 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 8 8 4.115221 $104.1600 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 3.058448 $106.9600 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 1.358448 $104.7800 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.166667 $54.1600 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 6 6 2.115221 $39.2400 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 4 4.033334 $83.4100 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.542085 $24.3900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.166667 $249.1700 $115.0000
EXIT -EXIT EXIT ASSESSMENT 111 111 84.042390 $4202.1400 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 2.517808 $139.7400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 0.210959 $15.8300 $75.0100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.505556 $25.8100 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 0.154338 $7.8800 $51.0700
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 15 16 11.061112 $564.6700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 5 5 2.594444 $132.4400 $51.0500
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Subtotal (Total Children Is Unduplicated) 154 202 142.627479 $6425.5400 $45.0500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.511111 $12555.5000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 3.522223 $176.1200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 7 16.825429 $841.2700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.166667 $498.3400 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 343 474 3825.699999 $191285.1200 $50.0000
INTR -T1013 INTERPRETER 12 17 156.752381 $7837.6300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 19 159.285714 $11379.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.714286 $326.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 9 12 85.714286 $6123.4300 $71.4400
SENS -V5060 BEHIND EAR HEARING AID
1 1 1.166667 $266.0100 $228.0100
SENS -V5264 EARMOLD 1 1 1.166667 $21.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 48 61 459.642857 $32836.8800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 45.714286 $634.5100 $13.8800
TRAV -TRAVS Travel by mile 54 76 656.838097 $292.2900 $0.4500
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Subtotal (Total Children Is Unduplicated) 777 1865 8787.811847 $432584.1800 $49.2300
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Total 2120 9784.059167 $439009.7200 $44.8700
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Number of Children (Unduplicated) With at Least One Authorization 851