Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 3963 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 31 36 77.635225 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 31 36 77.635225 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.361111 $6.4700 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 7 9 5.055555 $107.9300 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 8 1.894444 $23.8900 $12.6100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 9 5.055555 $41.7600 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 9 5.055555 $127.9500 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 7 2.327777 $179.5400 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 7 2.327777 $43.1800 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 3 3.077778 $63.6500 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 6 1.216666 $54.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 7 1.377777 $158.4400 $114.9900
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 31 44 123.914283 $6195.7200 $50.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 4.366667 $222.9200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.683333 $85.9300 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 43 116 157.714278 $7312.1300 $46.3600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 2 0.322222 $1611.0000 $4999.6600
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 2.950793 $147.5400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 244 314 278.922910 $13946.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 100 104 62.905475 $1572.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 85 95 69.165875 $3458.3100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 6.571429 $164.2900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 44 49 46.680952 $2334.0500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.900000 $72.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 61 67 45.188191 $2259.4000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 90 100 88.275399 $4413.7800 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 20.285715 $507.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1314 1737 12858.373033 $642919.1100 $50.0000
INTR -T1013 INTERPRETER 8 11 60.165078 $3008.2600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 171 235 1720.685718 $122925.8300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 244 334 2384.245246 $170330.5400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 1.600000 $91.4600 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 5 6 1.216666 $277.3800 $227.9900
SENS -V5264 EARMOLD 7 10 5.250792 $94.5100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 532 738 5753.842867 $411054.7600 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1839 3811 23409.548361 $1381188.6800 $59.0000
-------------------------------------------------------------------------------------------------------------------------------------
Total 3963 23644.897864 $1388500.8100 $58.7200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1857