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: 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 3105 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 9 9 7.588888 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.022222 $37.8200 $37.0000
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Subtotal (Total Children Is Unduplicated) 10 10 8.611110 $37.8200 $4.3900
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 11 10.526332 $146.0000 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 10 7.726332 $70.1600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 11 10.526332 $292.9500 $27.8300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 11 10.526332 $235.7900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 8 4.746119 $213.5700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 9 2.153425 $247.6400 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 9 9 9.000000 $450.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 13 13 13.000000 $663.6500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 13 15 15.000000 $765.7500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 10 10 9.700000 $495.1900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
SCREEN-T1023 SCREENING 66 66 67.295238 $3364.7700 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 3.000000 $153.1500 $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 23 23 23.000000 $1174.1500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 4.000000 $195.7600 $48.9400
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Subtotal (Total Children Is Unduplicated) 149 214 202.200110 $9154.0200 $45.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 6 10.638095 $53190.0000 $4999.9600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 2 3.066666 $153.3300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 8 13.833334 $691.6700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 5 16.800000 $1203.0500 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 14 15 26.300000 $1315.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 3.200000 $80.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 393 573 1650.533340 $82526.7000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 3.533333 $88.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 284 413 1222.214302 $61110.8000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 153 196 627.833339 $31391.7000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 299 380 1092.371430 $54618.5800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 6.466667 $161.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 413 533 3199.531742 $159976.8200 $50.0000
INTR -T1013 INTERPRETER 13 17 179.804765 $8990.2300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 135 171 831.759126 $59420.9100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 49 65 451.616665 $25832.4800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 99 128 732.978566 $52364.0000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 9 45.228571 $2585.2700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 5 7 6.022222 $1373.0600 $228.0000
SENS -V5264 EARMOLD 11 15 23.677777 $426.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 250 317 1966.255943 $140469.4000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 12 14 60.871427 $844.9000 $13.8800
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Subtotal (Total Children Is Unduplicated) 755 2881 12175.537310 $738879.0900 $60.6900
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Total 3105 12386.348530 $748070.9300 $60.3900
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Number of Children (Unduplicated) With at Least One Authorization 768