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 4614 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 98 126 115.148411 $5584.6900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 5.900000 $333.2900 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.022222 $14.1800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.194444 $4.6100 $23.6900
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.022222 $9.2800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.022222 $28.4500 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 9 8.400000 $712.6600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.344444 $17.5900 $51.0600
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.044444 $0.9900 $22.3800
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 3.333333 $150.0000 $45.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 0.552778 $27.6400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 122 127 213.806991 $10690.3500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.183333 $13.7500 $74.9900
SCREEN-T1023 SCREENING 4 4 4.088888 $204.4400 $50.0000
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
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Subtotal (Total Children Is Unduplicated) 232 288 355.569288 $17817.1900 $50.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 40 60 79.216669 $396084.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.120548 $6.0300 $49.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.216743 $60.8400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.183333 $13.1300 $71.6000
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 3.477777 $799.8700 $229.9900
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 189 238 347.523015 $17376.1600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 212 254 266.777766 $13338.8300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.200000 $5.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 175 199 230.510307 $11525.4600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 323 374 358.199192 $17909.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 4.083333 $102.0800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 25.971429 $1904.2200 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 135 173 1119.847620 $55992.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1175 2685 11131.661052 $111316.6300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 21 151.479364 $10821.7000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 2 3.600000 $205.9200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 18 24 146.370638 $10456.7400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 22.400000 $1280.3800 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 4 2.822221 $1286.8800 $455.9800
SENS -V5264 EARMOLD 5 5 4.933332 $88.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 38 43 242.622219 $17332.9200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.533333 $144.9000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 6.133333 $85.1300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1177 4316 14318.125133 $676421.1800 $47.2400
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Total 4614 14706.261087 $694238.3800 $47.2100
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Number of Children (Unduplicated) With at Least One Authorization 1182