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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 472 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 37 39 86.617461 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 37 39 86.617461 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.155556 $3.3200 $21.3600
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.155556 $1.2900 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.155556 $3.9400 $25.3200
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.155556 $12.0000 $77.1500
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.155556 $2.8900 $18.5600
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.900000 $45.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3 7 1.977780 $83.4300 $42.1900
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 6.428571 $321.4300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 75 104 86.549341 $4327.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 20 20 12.425728 $310.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 27 27 19.027091 $951.3500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 20 20 18.171613 $908.5800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 27 29 20.479907 $1023.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 31 31 40.314284 $2015.7100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.966667 $49.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 107 113 583.642854 $29182.1200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 16 84.600000 $6043.8300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 21 26 161.214286 $11517.1600 $71.4400
SENS -V5264 EARMOLD 1 1 0.155556 $2.8000 $18.0100
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 36 260.428573 $18604.9800 $71.4400
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Subtotal (Total Children Is Unduplicated) 253 426 1295.404471 $75259.2100 $58.1000
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Total 472 1383.999712 $75342.6400 $54.4400
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Number of Children (Unduplicated) With at Least One Authorization 287