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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 16756 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
CASE -CASE NON-TCM CASE MANAGEMENT 2 2 1.377778 $50.9800 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 125 141 465.052379 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1684 1966 66287.573229 $2452639.3600 $37.0000
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Subtotal (Total Children Is Unduplicated) 1702 2109 66754.003386 $2452690.3400 $36.7400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 60 72 54.014535 $2619.7100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.422222 $80.3400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.005556 $19.8200 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.005556 $23.6200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 2.005556 $27.8200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 6 3.027778 $71.7600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.257611 $11.4200 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 0.650000 $6.4700 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.005556 $27.9900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 3.005556 $115.6300 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 25 26 24.513165 $2079.6900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 28 29 17.813166 $909.7200 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 2.294445 $38.3200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 2.279833 $51.0700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 9 8.044444 $362.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 5 4.577777 $526.4400 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 269 274 538.750000 $26937.5000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 7.000000 $525.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 16 28.000000 $2100.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 36 57 69.366666 $5202.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 25 41.457143 $2300.8700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 198 200 338.500000 $25387.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 19 19 34.000000 $2550.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 32 32 57.000000 $4275.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 444 455 809.000000 $44899.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 349 438 753.000000 $56475.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 6.000000 $306.3000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 15 18.571036 $948.0600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 6 6.000000 $306.3000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 8.000000 $408.4000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 8 15.428571 $787.6300 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 8 7.865079 $117.9800 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 4.000000 $204.2000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 8 8 10.000000 $510.5000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 15 15 12.926418 $659.9000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 8.571429 $419.4800 $48.9400
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Subtotal (Total Children Is Unduplicated) 1013 1780 2908.359098 $182769.4700 $62.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 50 65 80.195661 $400977.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 3.444444 $172.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 20 37.285714 $1864.2900 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 1.939682 $138.9000 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 4.344445 $311.1100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 65 73 102.578320 $23592.9900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 327 370 508.782928 $25439.1600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 10 9.066667 $226.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 268 348 778.402409 $38920.2600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 8 10.950001 $273.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 94 117 247.958734 $12397.9600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.377778 $34.4500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 153 181 377.390486 $18869.5800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 48.566667 $1214.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 211 255 495.736520 $24786.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 5.333334 $133.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1844 2415 18226.501587 $911326.1100 $50.0000
INTR -T1013 INTERPRETER 189 242 1030.233479 $51511.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2088 3800 24596.094911 $245961.2000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 104 126 1008.371432 $72038.1000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 7 45.228571 $2587.0800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 193 251 1741.501874 $124412.9700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 19 20 141.931746 $8112.8300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 5 2.145814 $139.4800 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 5 1.156468 $131.8400 $114.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 10 8.056925 $3673.9500 $456.0000
SENS -V5264 EARMOLD 11 17 15.137594 $272.4800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 281 356 2623.007139 $187387.8500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 18 19 124.428572 $1727.0700 $13.8800
TRAV -TRAVS Travel by mile 2128 4128 25024.507176 $11135.9300 $0.4500
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Subtotal (Total Children Is Unduplicated) 2177 12867 77301.657078 $2169771.7700 $28.0700
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Total 16756 146964.019562 $4805231.5800 $32.7000
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Number of Children (Unduplicated) With at Least One Authorization 2306