Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 5447 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 56 62 49.555557 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.400000 $51.8000 $37.0000
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Subtotal (Total Children Is Unduplicated) 57 63 50.955557 $51.8000 $1.0200
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 4.714286 $59.4500 $12.6100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 3 0.985388 $8.1400 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 4 5.470451 $138.4600 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.366667 $28.2800 $77.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.366667 $6.8000 $18.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 1.019179 $45.8600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 11 14 14.852055 $1707.9900 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 21 25 5.690942 $284.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 20 20 17.273974 $863.7000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 8.010958 $600.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 7 7 10.010958 $750.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 225 225 378.956934 $28421.8100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 167 167 294.378857 $22078.4400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 94 94 139.627388 $10472.0900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 43 43 68.049311 $3776.7500 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 84 98 32.519043 $1660.0800 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.265449 $13.5500 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 19 6.594445 $336.6500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 45 49 20.707057 $1057.1000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 44 50 14.273517 $728.6700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.455556 $23.2600 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 13 16 6.113165 $312.0700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 35 35 15.882682 $810.8200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 1.844444 $94.1600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 134 156 68.851759 $3514.8700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 25 28 23.598411 $1204.6900 $51.0500
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Subtotal (Total Children Is Unduplicated) 582 1077 1146.890501 $79372.6100 $69.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 13 130.550686 $652753.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 10 7.048555 $352.4300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 7 8.803175 $440.1600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 5 3.522222 $810.1100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 20 26 10.733943 $536.7000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 10 8.955554 $223.8900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 295 405 329.553165 $16477.6200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 269 343 462.677787 $11566.9700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 220 488 309.427751 $15471.2600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 101 202 252.838892 $6320.9800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 98 218 128.835703 $6441.7300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 55 120 153.716667 $3842.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 237 290 243.689678 $12184.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 232 282 392.771435 $9819.3000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 11 86.428571 $2160.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 396 527 3790.961099 $189548.1900 $50.0000
INTR -T1013 INTERPRETER 1 2 1.022222 $51.1100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 228 294 1817.447251 $129838.5300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 199 266 2127.282142 $121680.6100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 125 166 1227.061909 $87661.3500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 89 124 859.778576 $49144.9600 $57.1600
SENS -V5060 BEHIND EAR HEARING AID
3 3 2.252055 $513.4800 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
5 7 5.019179 $2288.7600 $456.0000
SENS -V5264 EARMOLD 15 20 21.755555 $391.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 355 462 3731.344904 $266567.5600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 6 45.714286 $634.5200 $13.8800
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Subtotal (Total Children Is Unduplicated) 872 4307 16159.192962 $1587723.3800 $98.2600
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Total 5447 17357.039020 $1667147.7900 $96.0500
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Number of Children (Unduplicated) With at Least One Authorization 1040