Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 3257 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 15 16 15.022220 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 16 15.022220 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 5 5.585389 $77.4700 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 6 7.385388 $67.0600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 5 5.585389 $155.4400 $27.8300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 5 5.585389 $125.1200 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 4.066667 $183.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 1.504109 $172.9700 $115.0000
EXIT -EXIT EXIT ASSESSMENT 9 9 17.142857 $857.1500 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 19 20 20.133333 $1027.8100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 8 8.000000 $408.4000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 15 16 15.166667 $774.2600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
SCREEN-T1023 SCREENING 66 67 75.114285 $3755.7100 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 6.000000 $306.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 22 22 22.000000 $1123.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 3.000000 $146.8200 $48.9400
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Subtotal (Total Children Is Unduplicated) 141 183 201.269473 $9435.8500 $46.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 4.950793 $24754.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 3.066667 $153.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 6 11.433333 $571.6700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 3 6.266667 $448.7600 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 12 15 37.445238 $1872.2700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 409 597 1717.331763 $85866.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 6.633333 $165.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 287 421 1251.466675 $62573.3800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 10.433333 $260.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 161 209 637.660327 $31883.0600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 335 425 1172.100018 $58605.0900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 8 21.033333 $525.8300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 8.383333 $419.1700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 440 557 3578.371830 $178918.7500 $50.0000
INTR -T1013 INTERPRETER 7 7 87.214284 $4360.7300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 152 201 1027.464294 $73402.1300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 49 71 510.190479 $29182.9300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 102 133 729.684921 $52128.6600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 6 22.476190 $1284.7400 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 3 4 4.000000 $912.0000 $228.0000
SENS -V5264 EARMOLD 6 9 12.177777 $219.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 279 358 2329.219038 $166399.5100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.571429 $89.8800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 12 14 103.340477 $1434.3700 $13.8800
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Subtotal (Total Children Is Unduplicated) 795 3058 13293.915532 $776432.7800 $58.4100
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Total 3257 13510.207225 $785868.6300 $58.1700
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Number of Children (Unduplicated) With at Least One Authorization 819