Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 7843 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 12 12 8.983333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 7 7 3.944446 $145.9500 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 19 19 12.927779 $145.9500 $11.2900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.255556 $12.4000 $48.5100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.350000 $6.2700 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.350000 $7.4700 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.350000 $4.4100 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.350000 $7.5400 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.372222 $11.3300 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.350000 $3.1700 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 1.372222 $34.7300 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.350000 $12.2400 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 10 5.277777 $407.0700 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.350000 $6.4900 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 1.372222 $28.3800 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.044444 $92.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.044444 $235.1100 $115.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 1.000000 $75.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 13 13 21.857143 $1213.0700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 12 12 20.857143 $1564.2800 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 59 70 30.134126 $1538.3500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 199 234 87.423805 $4462.9700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 106 131 125.947611 $6429.6000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 0.511111 $26.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 174 198 144.626983 $7383.2000 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.366667 $18.7200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 394 454 293.847604 $15000.8500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 90 103 51.594445 $2633.9000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 744 1251 794.355525 $41214.6500 $51.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 2.000000 $10000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 1.661110 $382.0300 $229.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.833333 $41.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 241 286 216.450774 $10822.4500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.522222 $13.0600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 53 48.828570 $2441.4300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 768 913 682.912642 $34145.3500 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 138 157 1266.285715 $31657.1800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1166 1420 11571.705609 $578585.7400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1225 2672 13497.261894 $134972.6400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 224 275 1530.226209 $109319.2800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 10 52.919048 $3026.9700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 215 271 1798.019862 $128450.4900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 19 21 204.785713 $11705.5600 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.511111 $116.5300 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 1 1.022222 $466.1200 $455.9900
SENS -V5264 EARMOLD 2 2 1.533333 $27.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 317 381 2606.771450 $186227.7600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 21.857142 $1250.2300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 73.280954 $1017.1400 $13.8800
TRAV -TRAVS Travel by mile 51 91 73408.185727 $32666.6400 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1519 6573 106987.574640 $1277335.8600 $11.9400
-------------------------------------------------------------------------------------------------------------------------------------
Total 7843 107794.857944 $1318696.4500 $12.2300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1568