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: 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 4967 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 81 90 156.799209 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 81 90 156.799209 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.511111 $12.0100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.022222 $14.1800 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.022222 $9.2800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.022222 $28.4500 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.511111 $43.3600 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.022222 $17.0700 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.511111 $11.4500 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 2.755555 $124.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 2.755555 $316.8800 $115.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 5 18.576190 $928.8100 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 19 65.117463 $3255.8900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 23 44 96.826984 $4863.4600 $50.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.511111 $12555.5000 $4999.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.022222 $51.1100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 317 395 492.411586 $24620.6200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 142 150 132.693719 $3317.3500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 112 124 143.727770 $7186.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 103 113 186.251451 $9312.6000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 1.400000 $35.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 94 104 137.753178 $6887.6900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 1.600000 $40.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 126 135 151.385054 $7569.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 5.600000 $140.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1682 2159 16373.870636 $818694.4500 $50.0000
INTR -T1013 INTERPRETER 2 2 16.142857 $807.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 213 289 2134.106347 $152460.7300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 296 399 3180.115078 $227187.6500 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 2 3 2.244444 $511.7200 $228.0000
SENS -V5264 EARMOLD 4 5 4.288888 $77.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 703 936 7798.261907 $557108.2900 $71.4400
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Subtotal (Total Children Is Unduplicated) 2275 4833 30767.386248 $1828612.7200 $59.4300
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Total 4967 31021.012441 $1833476.1800 $59.1000
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Number of Children (Unduplicated) With at Least One Authorization 2332