Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 02-06-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 8174 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 5 6 5.710502 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 6 5.710502 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 85 118 70.236475 $3406.4900 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.022222 $20.1500 $19.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.022222 $14.1800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.360197 $8.5400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.022222 $9.2800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.022222 $28.4500 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 4.857143 $218.5700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 5.722897 $658.1200 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 4 4 55.285714 $2695.7400 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 1 2 0.511111 $25.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 118 119 123.487521 $6174.3800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 12.005479 $666.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 108 109 180.097253 $13507.3200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 58 58 101.679906 $7626.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 165 165 248.213684 $13775.9000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 98 98 169.568489 $12717.6500 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.0900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 7 8 3.434170 $175.3200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 16 18 18.322734 $935.3900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 48 55 21.955709 $1120.8600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 10 15 4.271613 $218.0700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 11.832441 $604.0400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 23 24 45.630095 $2329.4100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 65 76 32.653874 $1667.0000 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 9 10 6.672223 $340.6200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 0.573211 $29.2600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 59 63 20.476259 $1045.3300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 10 11 7.100000 $362.4600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 7 2.279148 $111.5400 $48.9400
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Subtotal (Total Children Is Unduplicated) 502 994 1165.832824 $71554.3300 $61.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 95 136 83.264024 $416323.0000 $5000.0300
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.084932 $6.0800 $71.5800
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.049315 $3.5300 $71.5900
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 1.613699 $371.1300 $229.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 82 88 93.252478 $4662.6300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 1.538851 $38.4700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 613 822 1806.642275 $90332.4400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 13 13 24.669048 $616.7300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 278 339 677.065109 $33853.4200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 8.650000 $216.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 69 128.655563 $6432.8200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.166667 $4.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 490 593 1286.542907 $64327.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 9.550001 $238.7500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 9 9 89.285715 $6546.4300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 28 31 2949.000001 $73725.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 676 849 7206.833365 $360341.9200 $50.0000
INTR -T1013 INTERPRETER 25 36 123.255186 $6162.7700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 734 1431 8270.508390 $82705.1700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 122 151 1212.852390 $86646.2000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 139 174 1451.713899 $103710.4900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 22.714286 $1298.3500 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.361644 $82.4400 $227.9700
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.504110 $114.9300 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 4.857143 $2214.8400 $456.0000
SENS -V5264 EARMOLD 5 6 6.659883 $119.8800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 134 158 1347.783015 $96285.6900 $71.4400
TRAV -TRAVS Travel by mile 825 2244 622432.980111 $276982.6800 $0.4500
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Subtotal (Total Children Is Unduplicated) 865 7174 649241.054007 $1714363.5800 $2.6400
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Total 8174 650412.597333 $1785917.9100 $2.7500
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Number of Children (Unduplicated) With at Least One Authorization 873