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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2910 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 53 62 55.161109 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 53 62 55.161109 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 18.394912 $1039.1300 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 18.394912 $362.5700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 16 16 24.809666 $582.7800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 10 10 15.252055 $211.5500 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 12 13 30.571429 $724.5400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 21 23 22.037443 $200.1000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 32 35 33.483713 $931.8500 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 8 8 13.533333 $1148.1700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.533333 $78.3100 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 49 54 50.108524 $836.8100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 7.000000 $156.8000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 2.044444 $235.1100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 81 81 88.242945 $4412.1600 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.139727 $10.4800 $74.9900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 0.139727 $7.7500 $55.4900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 34 34 7.178077 $398.3900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 34 35 2.589035 $194.2000 $75.0100
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 3.000000 $153.1500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 10 10 13.000000 $663.6500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 37 38 52.969514 $2704.0900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.0900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 9 11.000000 $561.5500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 17 17 12.683181 $647.4800 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 2.216667 $113.1600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 1.344444 $68.6300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 50 52 35.644898 $1819.6600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 7 7 7.000000 $357.3500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 9 9 4.098935 $200.6100 $48.9400
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Subtotal (Total Children Is Unduplicated) 316 492 482.922025 $19018.0500 $39.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 4.112329 $20561.5000 $4999.9600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 7 4.592238 $229.6100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.400000 $28.6400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 10.211111 $2348.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 123 145 135.295361 $6764.8000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 7 5.666667 $141.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 268 387 988.761921 $49438.1400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 6 8.866665 $221.6600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 66 76 190.742863 $9537.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 2.833334 $70.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 42 51 116.642861 $5832.1700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 3 4.299999 $107.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 99 125 299.961913 $14998.1300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 3.766666 $94.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 963 1255 11404.459500 $570223.5000 $50.0000
INTR -T1013 INTERPRETER 4 5 76.209523 $3810.4800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 50 59 574.999999 $41078.0500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 6.571429 $375.8800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 37 45 404.352378 $28886.9800 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.422222 $192.5200 $455.9800
SENS -V5264 EARMOLD 1 1 2.044444 $36.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 119 152 1249.607142 $89272.0200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 10.714286 $612.8600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 82.714286 $1148.0700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1041 2356 15589.249137 $846061.6900 $54.2700
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Total 2910 16127.332271 $865079.7400 $53.6400
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Number of Children (Unduplicated) With at Least One Authorization 1093