Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 2127 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 72 85 215.957139 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 72 85 215.957139 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.032877 $1.8600 $56.5300
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.533333 $10.5100 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.533333 $36.0200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.722374 $23.8900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 5.044444 $119.5500 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 10 17.247619 $156.6100 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 9 9 18.314286 $509.6900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.533333 $58.9900 $38.4700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 7 7 14.247619 $237.9300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.533333 $34.3500 $22.4000
EXIT -EXIT EXIT ASSESSMENT 120 121 129.555501 $6477.7800 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 9 9 0.728766 $40.4500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 0.200000 $15.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 7 11.066667 $564.9600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.216667 $113.1600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.382877 $19.5500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 12.143651 $619.9300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 1.836530 $89.8800 $48.9400
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Subtotal (Total Children Is Unduplicated) 170 208 228.873210 $9589.5500 $41.9000
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.533333 $26.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 18 14.954709 $747.7500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 152 180 124.761297 $6238.1300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 17 10.433333 $260.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 383 596 1684.129393 $84206.6400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 4.966667 $124.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 79 96 289.924925 $14496.2600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 31.957143 $798.9300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 68 189.106356 $9455.3500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 6.133334 $153.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 166 207 597.552394 $29877.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.066666 $26.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 399 532 4691.528565 $234576.6300 $50.0000
INTR -T1013 INTERPRETER 5 7 90.519047 $4525.9500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 23 27 214.842857 $15348.3900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 10 11 117.714285 $8409.5200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.377778 $21.6000 $57.1600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5264 EARMOLD 1 1 1.044444 $18.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 45 54 612.399998 $43749.9100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 39.714285 $551.2400 $13.8800
TRAV -TRAVS Travel by mile 5 5 47.857144 $21.3000 $0.4500
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Subtotal (Total Children Is Unduplicated) 779 1834 8772.517953 $453749.7100 $51.7200
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Total 2127 9217.348302 $463339.2500 $50.2700
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Number of Children (Unduplicated) With at Least One Authorization 892