Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 6155 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 5 6 13.147619 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 4 19.419047 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 10 32.566666 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 101 130 121.148411 $5875.6900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 14 14 11.194216 $632.3600 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.4900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.111111 $15.4100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 24 24 27.309523 $647.2400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.111111 $10.0900 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.111111 $30.9200 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 26 29 32.077778 $2721.4800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 0.855555 $43.6900 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 2.811111 $62.9700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 29 30 24.994444 $1124.7500 $45.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 0.552778 $27.6400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 127 132 220.806991 $11040.3500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.183333 $13.7500 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 3 4.183333 $313.7500 $75.0000
SCREEN-T1023 SCREENING 23 27 21.333328 $1066.6400 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.388889 $19.8500 $51.0500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.355556 $12.7900 $35.9800
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 3 3 2.044445 $154.8100 $75.7200
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
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Subtotal (Total Children Is Unduplicated) 326 413 475.078580 $23862.9500 $50.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 64 107 126.094445 $630472.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.120548 $6.0300 $49.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 1.388965 $69.4500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 7 7 1.924277 $137.8000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 16 16 8.805555 $2025.2700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 179 204 165.069686 $8253.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 1.172223 $29.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 190 239 348.545237 $17427.2700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 213 255 270.244433 $13512.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.200000 $5.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 176 200 234.510307 $11725.4600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 324 375 359.732525 $17986.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 4.083333 $102.0800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 7 57.376190 $4206.8200 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 837 1080 6896.128564 $344806.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1175 2687 11149.803909 $111498.0500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 133 162 992.576190 $70909.6700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 7 8 18.933334 $1082.9900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 134 162 890.380159 $63608.7900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 7 62.520634 $3573.6800 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 8 8 5.205555 $2373.7100 $456.0000
SENS -V5264 EARMOLD 9 9 7.088888 $127.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 133 171 1032.282135 $73746.2600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 3.305556 $189.0800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 84.358730 $1170.9000 $13.8800
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Subtotal (Total Children Is Unduplicated) 1182 5732 22721.851378 $1379046.5700 $60.6900
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Total 6155 23229.496624 $1402909.5100 $60.3900
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Number of Children (Unduplicated) With at Least One Authorization 1189