Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 6403 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 2 2 0.722223 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 6 45.161905 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 8 45.884128 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 59 65 49.121156 $2382.3700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 28 29 17.238094 $885.1700 $51.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 2.111111 $26.6200 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 6 3.061110 $65.9600 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 2.111111 $17.4400 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 3.111111 $78.7400 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 23 25 11.922222 $919.5600 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $18.5500 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 20 20 8.722223 $180.3800 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 7 3.844446 $173.0100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.511112 $58.7900 $115.0200
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.433333 $21.6700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 117 133 148.163193 $7408.1300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.711111 $53.3300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 21 37.966666 $2847.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.088889 $156.6700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 12 21 38.977777 $2923.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 1.788889 $99.2800 $55.5000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.450000 $22.9700 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.422222 $6.3300 $15.0000
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Subtotal (Total Children Is Unduplicated) 264 350 333.755776 $18345.7900 $54.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 50 69 79.124276 $395621.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 7 3.838889 $191.9500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 8 8 2.438433 $174.6200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 10 10 5.672222 $1304.6100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 138 164 200.860103 $10043.0200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 766 1379 1289.402084 $64469.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 5 3.388888 $84.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 25 26 30.511112 $1525.5600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 13 18.638889 $931.9500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 41 47 60.382536 $3019.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 8.466666 $211.6700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 7 40.785713 $2990.4100 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 3 5.622222 $0.0000 $0.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 13 20 133.588889 $6679.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1032 1333 9013.950005 $450697.7900 $50.0000
INTR -T1013 INTERPRETER 3 3 14.151076 $707.5600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1115 2796 11461.948376 $114619.5000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 42 50 373.761907 $26701.5700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 25.257143 $1444.7100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 46 53 251.588889 $17973.5000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 12.888889 $736.7300 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
3 4 2.722223 $1241.3700 $456.0100
SENS -V5264 EARMOLD 6 7 5.111112 $92.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 26 28 218.613492 $15617.7600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.555556 $260.5800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 3 12.566667 $174.4300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1126 6045 23280.836257 $1117540.4000 $48.0000
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Total 6403 23660.476161 $1135886.2000 $48.0100
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Number of Children (Unduplicated) With at Least One Authorization 1128