Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 07-01-17 and 06-30-18 Date of Report: 08-10-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 8369 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 6 6 3.011110 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 11 56.652381 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 17 59.663491 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 9 11 10.438890 $506.2900 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.677778 $14.4700 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 12 12 5.305556 $66.9000 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 149 163 253.722227 $5467.7300 $21.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 14 10.994445 $494.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 15 12.388888 $1424.7100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.005556 $0.2800 $50.4000
EXIT -EXIT EXIT ASSESSMENT 17 17 154.499999 $7725.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 3 2.822222 $211.6700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 57 90 114.764284 $8607.3100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 89 169 222.181752 $16663.6800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 6 4.844444 $363.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 53 82 79.527783 $5964.6200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 104 182 182.405558 $10123.5200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 16 29.883334 $2241.2600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 89 90 558.500000 $30996.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 67 70 139.516667 $10463.7500 $75.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.294444 $15.0300 $51.0400
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.172222 $2.5800 $15.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.011111 $51.6200 $51.0500
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Subtotal (Total Children Is Unduplicated) 391 946 1785.957160 $101555.2500 $56.8600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 30 23.616667 $118083.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.172222 $8.6100 $49.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 10 43.387302 $2169.3700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.616667 $44.1600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 74 85 58.866668 $13539.3600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 134 155 213.767460 $10688.3800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 8.655556 $216.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 479 880 1828.452807 $91422.7500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 22 23 37.161904 $929.0500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 26 27 25.699999 $1285.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 21 23 39.813492 $1990.6800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 6.466667 $161.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 15 15 22.133334 $1106.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.100000 $52.5000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 35 41 149.787300 $10982.3900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 45 52 391.226979 $9780.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1356 2435 25099.720645 $1254985.9000 $50.0000
INTR -T1013 INTERPRETER 3 3 26.866666 $1343.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1397 3492 27756.755584 $277567.5500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 32 44 500.347619 $35744.8500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 9 9 61.742857 $3531.6800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 5 5 38.792064 $2771.3100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 6.733333 $384.8800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 3 2.027778 $131.8100 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 3 2.488888 $567.4500 $227.9900
SENS -V5060 BEHIND EAR HEARING AID 3 3 1.522222 $347.0600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 10 13.938889 $6356.1400 $456.0000
SENS -V5264 EARMOLD 8 15 17.444443 $314.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 21 189.914284 $13567.4900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 13.214286 $755.8600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 49.038096 $680.6500 $13.8800
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Subtotal (Total Children Is Unduplicated) 1403 7406 56632.472678 $1861511.0900 $32.8700
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Total 8369 58478.093329 $1963066.3300 $33.5700
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Number of Children (Unduplicated) With at Least One Authorization 1413