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: 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 3294 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 4 8 4.088890 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.033333 $1.2300 $36.9600
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Subtotal (Total Children Is Unduplicated) 5 9 4.122223 $1.2300 $0.3000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 7 9.298022 $128.9600 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 7 9.298022 $84.4300 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 7 9.298022 $258.7700 $27.8300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 9.298022 $208.2800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 4.726941 $212.7200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 6 2.043836 $235.0500 $115.0000
EXIT -EXIT EXIT ASSESSMENT 7 7 7.000000 $350.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 23 23 23.000000 $1174.1500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 9 9.000000 $459.4500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 15 16 16.800000 $857.6400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
SCREEN-T1023 SCREENING 89 92 92.700000 $4635.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 6.285714 $320.8900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 7.000000 $357.3500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 34 35 35.200000 $1796.9600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $48.9400 $48.9400
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Subtotal (Total Children Is Unduplicated) 177 234 244.948579 $11281.7200 $46.0600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 6 6.212698 $31063.0000 $4999.9200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 2 3.066667 $153.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 5 11.100001 $555.0100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 7 23.833333 $1706.7000 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 24 26 32.816668 $1640.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.366667 $34.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 442 665 1765.337310 $88266.9100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 290 421 1184.942863 $59247.1800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 143 201 534.353965 $26717.6900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 324 416 1068.200014 $53410.0700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 7.933333 $198.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 445 572 3455.091254 $172754.6900 $50.0000
INTR -T1013 INTERPRETER 17 20 207.990476 $10399.5200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 117 163 747.336504 $53389.7700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 43 62 429.519045 $24568.5000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 99 140 784.838092 $56068.8200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 3.176190 $181.5500 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 5.022222 $1145.0600 $228.0000
SENS -V5264 EARMOLD 9 11 20.566667 $370.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 236 310 1924.645223 $137496.7600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 13 15 84.999999 $1179.8000 $13.8800
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Subtotal (Total Children Is Unduplicated) 759 3051 12302.349191 $720547.8900 $58.5700
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Total 3294 12551.419993 $731830.8500 $58.3100
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Number of Children (Unduplicated) With at Least One Authorization 773