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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 15610 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 4 4 2.533333 $93.7300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 128 147 688.991735 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1278 1315 46675.338100 $1726987.5400 $37.0000
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Subtotal (Total Children Is Unduplicated) 1326 1466 47366.863168 $1727081.2800 $36.4600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 64 77 62.714459 $3041.6500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 3.033334 $171.3600 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.505556 $29.6800 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.505556 $35.3700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.505556 $20.8800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 4 2.516667 $59.6500 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 2.754871 $25.0100 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.366667 $3.6500 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.505556 $41.9000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 4 5.505556 $211.8000 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 27 29 26.960426 $2287.3200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 9 9 7.615982 $388.9500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.505556 $25.1400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 1.754871 $39.3100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 9 7.777093 $349.9700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 3.022222 $347.5500 $115.0000
EXIT -EXIT EXIT ASSESSMENT 221 223 445.000000 $22250.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 20 20 36.500000 $2737.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 31 45 81.005479 $6075.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 20 30 56.000000 $3108.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 148 148 267.500000 $20062.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 27 27 47.500000 $3562.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 14 24.000000 $1800.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 346 349 637.285714 $35369.3600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 286 340 606.571428 $45492.8600 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 5.268493 $268.9600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 18.000000 $918.9000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 6.392563 $326.3400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 14 15 18.000000 $918.9000 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 8 24.615873 $369.2400 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 12 13 16.000000 $816.8000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 5 5.000000 $255.2500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 35 39 50.895499 $2598.2200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 5.000000 $222.7500 $44.5500
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Subtotal (Total Children Is Unduplicated) 837 1469 2492.084977 $154815.0100 $62.1200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 52 60 86.221235 $431107.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.505556 $25.2800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 24 26 36.100619 $1805.0300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 4.497619 $322.0700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 36 41 47.215699 $10859.5900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 414 460 562.171639 $28108.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 48 50 59.144141 $1478.6100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 261 348 782.902364 $39145.0400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 10.300000 $257.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 110 136 260.944435 $13047.1800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.933333 $123.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 141 197 367.805550 $18390.2500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 44.566667 $1114.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 220 291 575.070614 $28753.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 8 15.283334 $382.0900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1706 2310 17369.233339 $868461.6700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 8 11.819047 $590.9600 $50.0000
INTR -T1013 INTERPRETER 180 238 1042.848413 $52142.4400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1956 3720 23822.353722 $238223.5100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 102 130 1035.666668 $73988.0600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 20.266667 $1159.2600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 177 244 1699.834127 $121436.1600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 15 18 89.604764 $5121.8200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 3 2.203044 $143.2000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 3 1.191933 $135.8800 $114.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 8 9.191933 $4191.5100 $456.0000
SENS -V5264 EARMOLD 11 16 25.396413 $457.1400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 267 345 2730.215875 $195046.5900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 7 20.999999 $1500.2400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 22 25 194.723811 $2702.7600 $13.8800
TRAV -TRAVS Travel by mile 1993 3966 24183.337416 $10761.5800 $0.4400
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Subtotal (Total Children Is Unduplicated) 2049 12675 75116.549976 $2150981.8900 $28.6400
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Total 15610 124975.498121 $4032878.1800 $32.2700
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Number of Children (Unduplicated) With at Least One Authorization 2172