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 10391 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 103 117 433.527775 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 147 160 5336.530176 $197451.5400 $37.0000
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Subtotal (Total Children Is Unduplicated) 243 279 5771.435729 $197502.5200 $34.2200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 52 63 42.970091 $2084.0500 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.005556 $0.1100 $19.8700
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.005556 $0.1300 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.005556 $0.0800 $13.9800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 3 0.327778 $7.7700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 0.257611 $2.3400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.005556 $0.1600 $28.0400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.005556 $77.1600 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 3.274277 $277.7900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 9 9 3.229833 $164.9500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.005556 $0.0900 $16.8300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 0.257611 $5.7700 $22.4100
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 1.644444 $74.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.644444 $74.1100 $114.9900
EXIT -EXIT EXIT ASSESSMENT 266 271 532.750000 $26637.5000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 3 2.407143 $133.5900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 18.500000 $1387.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 39 39 68.500000 $3801.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 24 27 48.000000 $3600.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 1.183562 $60.4200 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 3 1.179365 $17.6900 $15.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 3.000000 $153.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 374 457 734.659495 $38825.7600 $52.8500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 8.000000 $40000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.911111 $45.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 9 9 15.584126 $779.2100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.428571 $102.3000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 10 12 12.399543 $2851.8900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 316 354 491.140071 $24557.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 10 9.066667 $226.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 264 342 770.202409 $38510.2600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 8 10.950001 $273.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 93 116 244.892067 $12244.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.377778 $34.4500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 149 176 366.990486 $18349.5800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 48.566667 $1214.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 206 249 484.703186 $24235.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 5.333334 $133.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 125 148 1104.614287 $55230.8100 $50.0000
INTR -T1013 INTERPRETER 156 201 883.028718 $44151.4700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2087 3796 24571.675863 $245717.0100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 15 91.123811 $6509.8800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 19 27 153.561904 $10970.4600 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 3 0.677321 $44.0200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 3 0.387975 $44.2300 $114.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 0.355099 $161.9300 $456.0000
SENS -V5264 EARMOLD 2 3 0.777777 $14.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 38 257.971426 $18429.5100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.142857 $182.4200 $13.8800
TRAV -TRAVS Travel by mile 2126 4122 24969.507176 $11111.4600 $0.4500
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Subtotal (Total Children Is Unduplicated) 2159 9655 54518.370231 $556125.1900 $10.2000
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Total 10391 61024.465455 $792453.4700 $12.9900
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Number of Children (Unduplicated) With at Least One Authorization 2213