Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 2882 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 47 52 57.751584 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 47 52 57.751584 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 13 13 26.291193 $1485.1900 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.139726 $22.4600 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 15 15 21.345554 $501.4100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 7 9.139726 $126.7700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 9 13.000000 $308.1000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 20 22 20.391781 $185.1600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 31 32 29.496499 $820.8900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 10.000000 $848.4000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.172603 $8.8100 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 47 48 45.526028 $760.2800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 5.922222 $132.6600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.252055 $56.3400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 1.866667 $214.6700 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 79 79 87.097264 $4354.8600 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.126027 $9.4600 $75.0400
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 0.126027 $7.0000 $55.5300
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 43 43 1.605472 $89.1300 $55.5100
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 43 43 1.605472 $120.4400 $75.0200
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 2 2.000000 $102.1000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 11.000000 $561.5500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 10 10 14.000000 $714.7000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 35 35 30.705707 $1567.5200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 2 0.511111 $26.0900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 33.714286 $1721.1200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 19 20 16.324277 $833.3600 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 8 8 3.972221 $202.7800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.244444 $12.4800 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 52 58 38.883333 $1984.9900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.252055 $12.3400 $48.9500
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Subtotal (Total Children Is Unduplicated) 312 483 432.711750 $18020.0900 $41.6400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 3.000000 $15000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.944444 $47.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 2.252055 $112.6100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 8.022222 $1845.1100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 116 140 154.403982 $7720.2700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 4 8.711112 $217.7800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 286 389 1071.009550 $53550.5900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 2 3.066667 $76.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 69 82 208.433338 $10421.6900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 3.066667 $76.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 53 149.361911 $7468.1300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 95 113 256.042863 $12802.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 3 5.933334 $148.3400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1031 1295 12426.092787 $621305.2100 $50.0000
INTR -T1013 INTERPRETER 2 2 18.466667 $923.3400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 50 60 565.303169 $40385.3200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 31 39 397.438093 $28393.0200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 8.142857 $465.4500 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 2.044444 $932.2500 $455.9900
SENS -V5264 EARMOLD 1 2 1.866667 $33.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 103 132 1107.961891 $79152.8500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 26.285714 $1503.5500 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 8 11 65.428571 $908.1500 $13.8800
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Subtotal (Total Children Is Unduplicated) 1100 2347 16494.279005 $883561.5400 $53.5700
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Total 2882 16984.742339 $901581.6300 $53.0800
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Number of Children (Unduplicated) With at Least One Authorization 1159