Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-18 and 12-31-18 Date of Report: 02-05-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 12706 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 140 153 322.030950 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 1.811111 $67.0100 $37.0000
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Subtotal (Total Children Is Unduplicated) 142 155 323.842061 $67.0100 $0.2100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 62 72 51.765298 $2510.6300 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.7100 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 4 5.000000 $117.4500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 5.222222 $72.4300 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 12 13 12.199998 $289.1400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 4 2.090259 $18.9800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 3.000000 $83.4900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 3.266667 $125.6700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 5 7.140259 $605.7800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 16 16 11.901369 $607.8000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.101370 $18.3900 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 5 4.668037 $104.5700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 8 8.785388 $395.3400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 6.548554 $753.0800 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 2.000000 $100.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 202 206 409.500000 $20475.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 4.766668 $357.5100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 14 18 20.250000 $1518.7500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 13 10.350001 $574.4300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 144 144 247.022146 $18526.6700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 11.000000 $825.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 409 410 667.883561 $37067.5400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 394 467 725.642857 $54423.2200 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 3.087671 $157.6300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 7 9.000000 $459.4500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 7.224658 $368.8200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 8 8 7.763166 $396.3100 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 5 15.250467 $228.7600 $15.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 2 3 5.000000 $255.2500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 6.134246 $313.1600 $51.0500
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Subtotal (Total Children Is Unduplicated) 830 1468 2289.064862 $142686.6400 $62.3300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 52 62 115.018872 $575095.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 6 5.255556 $262.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 37 41 30.422221 $1521.1100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 8.736508 $625.6200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 26 28 46.218069 $10630.1200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 249 277 288.319710 $14416.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 8 12.800000 $320.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 242 311 733.779811 $36689.0900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 4.600000 $115.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 59 72 164.749214 $8237.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 7.966667 $199.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 124 154 315.223024 $15761.1900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.766667 $44.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 189 231 475.774233 $23788.8200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 8 11.900001 $297.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1716 2141 17023.241301 $851162.9700 $50.0000
INTR -T1013 INTERPRETER 165 193 745.675245 $37283.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1944 3294 22901.623480 $229016.4600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 60 80 695.575396 $49691.9500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 26.857143 $1536.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 198 239 1874.723805 $133930.3900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 18 18 133.296825 $7619.2600 $57.1600
RSPT -RSPT RESPITE 1 1 3.571429 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 2.044444 $132.8900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 2.359665 $268.9900 $114.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 4 3.526332 $1607.9900 $456.0000
SENS -V5264 EARMOLD 5 8 9.029831 $162.5400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 236 291 2441.861905 $174446.8100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 91.209524 $1265.9900 $13.8800
TRAV -TRAVS Travel by mile 2012 3588 23642.276216 $10520.8400 $0.4500
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Subtotal (Total Children Is Unduplicated) 2056 11083 71819.403094 $2186650.1600 $30.4500
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Total 12706 74432.310017 $2329403.8100 $31.3000
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Number of Children (Unduplicated) With at Least One Authorization 2200