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: 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 4676 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 51 59 147.214289 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 51 59 147.214289 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 2 0.511111 $10.0700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 4 1.005556 $23.6200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 5 1.516667 $21.0400 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 4 1.005556 $9.1300 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 5 1.516667 $42.2100 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 4 1.005556 $85.3200 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 5 1.516667 $25.3300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 2 0.494445 $11.0800 $22.4000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.511111 $58.7800 $115.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 6 34.923810 $1746.1900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 12 61.260318 $3063.0200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 3 3.000000 $153.1500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 6 5.095890 $260.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 8 7.455556 $380.6100 $51.0500
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Subtotal (Total Children Is Unduplicated) 29 67 120.818910 $5889.6800 $48.7500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 1.272222 $6361.0000 $4999.9100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 4 1.516667 $75.8400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.142857 $225.0600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 294 361 340.207870 $17010.3800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 115 119 97.423541 $2435.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 104 120 132.166502 $6608.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.466667 $11.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 87 94 128.459933 $6423.0300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 4.100000 $102.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 101 119 156.849745 $7842.5200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 4.066667 $101.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 119 131 166.229335 $8311.4800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.272222 $106.8100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1592 2070 16061.838097 $803092.9300 $50.0000
INTR -T1013 INTERPRETER 3 5 54.571429 $2728.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 183 250 1921.180955 $137249.3200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 17.714286 $1013.2600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 285 392 3135.735722 $224017.1100 $71.4400
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.511111 $116.5300 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 5 8 4.050000 $72.9000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 640 856 6978.666663 $498556.4300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.142857 $182.4200 $13.8800
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Subtotal (Total Children Is Unduplicated) 2164 4550 29229.585348 $1723331.3400 $58.9600
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Total 4676 29497.618547 $1729221.0200 $58.6200
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Number of Children (Unduplicated) With at Least One Authorization 2205