Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 10278 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
CASE -CASE NON-TCM CASE MANAGEMENT 3 3 2.844444 $105.2400 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 113 127 502.354763 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 165 188 5899.800020 $218292.5800 $37.0000
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Subtotal (Total Children Is Unduplicated) 276 318 6404.999227 $218397.8200 $34.1000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 57 66 48.334854 $2344.2500 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 2 0.477778 $9.4200 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 0.477778 $11.2200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 2 0.477778 $6.6300 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 3 1.500000 $35.5500 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 4 0.705175 $6.4000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 2 0.477778 $13.3000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 4 4.477778 $172.2600 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 5 2.727397 $231.3900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 3 1.227397 $62.6800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 2 0.477778 $7.9800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 4 0.705175 $15.8000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.702815 $121.6300 $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 205 208 413.750000 $20687.5000 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 26.500000 $1987.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 43 44 84.785714 $4705.6100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 41 47 92.000000 $6900.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 4.000000 $204.2000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.022222 $15.3300 $15.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 326 431 704.871861 $38829.0000 $55.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 13.000000 $65000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 14 16 12.697260 $634.8700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 10 10 11.900000 $2737.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 314 344 494.591447 $24729.6000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 13 13 34.852381 $871.3100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 264 339 738.595248 $36929.8200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 5.733333 $143.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 107 125 241.603971 $12080.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.166667 $79.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 148 184 357.288102 $17864.4400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 92.000000 $2300.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 224 276 522.738100 $26136.9400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 15.899999 $397.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 124 156 1109.722217 $55486.1800 $50.0000
INTR -T1013 INTERPRETER 200 216 1042.292849 $52114.6900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2130 3702 24459.486980 $244595.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 9 63.561904 $4540.8600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 15 21 164.714285 $11767.1800 $71.4400
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 2.044444 $132.8900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.022222 $116.5300 $114.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.022222 $466.1200 $455.9900
SENS -V5264 EARMOLD 1 1 2.044444 $36.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 25 33 235.228569 $16804.7500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 2 13.142857 $182.4200 $13.8800
TRAV -TRAVS Travel by mile 2172 4059 24938.270672 $11097.5400 $0.4500
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Subtotal (Total Children Is Unduplicated) 2210 9529 54577.620173 $587245.2200 $10.7600
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Total 10278 61687.491261 $844472.0400 $13.6900
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Number of Children (Unduplicated) With at Least One Authorization 2278