Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 3284 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 1 1 1.000000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 1.211111 $44.8100 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3 3 2.211111 $44.8100 $20.2700
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 6 7.307762 $92.1500 $12.6100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 7 8.307762 $68.6200 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 6 8.266666 $209.2300 $25.3100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $18.5500 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 5 6.307762 $130.4400 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 2.731507 $122.9200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 6 2.731507 $314.1300 $115.0000
EXIT -EXIT EXIT ASSESSMENT 10 10 9.131507 $456.5800 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 4 4.000000 $204.2000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 20 20 15.989956 $816.2900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 11 12.158252 $620.6800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.688889 $35.1700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 11 10.049315 $513.0200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 60 62 57.561338 $2878.0600 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 12 12 12.000000 $612.6000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 3.156165 $161.1200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 33 34 33.299999 $1699.9600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 9 9 9.000000 $459.4500 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 163 217 204.688387 $9464.2200 $46.2400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.071233 $5356.0000 $4999.8500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 8 12.318722 $615.9400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 2.100000 $150.3800 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 9 9 13.412501 $670.6300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 6.133333 $153.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 413 571 1550.351601 $77517.6500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.266667 $56.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 296 411 1170.848423 $58542.4800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 2.083334 $52.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 158 213 585.704766 $29285.2600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 374 471 1273.928593 $63696.5400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 16.733334 $418.3400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 14.285714 $714.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 6 11.605806 $580.3000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 439 566 3721.560431 $186078.1100 $50.0000
INTR -T1013 INTERPRETER 6 8 81.914286 $4095.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 144 181 900.790880 $64352.5500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 41 53 352.585714 $20167.9200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 98 132 725.665473 $51841.5200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 9 10 61.860714 $3535.9600 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 6.252055 $1425.4800 $228.0000
SENS -V5264 EARMOLD 7 8 7.044445 $126.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 297 387 2427.051183 $173388.5200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 5.428571 $310.5200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 39.571429 $549.2500 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 759 3064 12992.569208 $743682.2200 $57.2400
-------------------------------------------------------------------------------------------------------------------------------------
Total 3284 13199.468706 $753191.2400 $57.0600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 769