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: 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 4872 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 49 51 122.938887 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 49 51 122.938887 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 2.000000 $97.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 39 40 62.076712 $3506.7100 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.7100 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 24 24 59.566667 $1399.2200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 12 12 15.011111 $208.2000 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 23 24 31.361111 $743.2600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 34 38 36.108838 $327.8700 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $9.9600 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 46 49 50.633540 $1409.1300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 4.011111 $154.3100 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 13 15 17.022222 $1444.1600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 7 9 6.441400 $328.9700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 65 71 69.049315 $1153.1200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 11 12.044444 $269.7900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 7 6.730594 $302.8800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 6.527778 $750.7000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 132 134 159.066666 $7953.3400 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.095890 $7.2000 $75.0900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 8.095890 $449.3300 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 24 24 14.632877 $812.1400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 24 24 14.632877 $1097.4800 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 2.000000 $102.1000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 9.571429 $488.6200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 26 27 34.719047 $1772.4100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 66 68 75.613853 $3860.0900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.977778 $49.9200 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 16 16 44.127778 $2252.7200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 32 36 43.738282 $2232.8500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 10 10 9.372223 $478.4600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 9 9 22.505556 $1148.9100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 120 125 122.232945 $6240.0000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 14 14 15.000000 $765.7500 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.027778 $1.4200 $51.0900
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 15 15 11.030823 $491.4300 $44.5500
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Subtotal (Total Children Is Unduplicated) 528 833 970.026535 $42431.2500 $43.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 6.560959 $32805.0000 $5000.0300
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.677778 $83.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 12 14 12.049542 $602.4800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 6.833333 $489.3300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 13 13 16.255556 $3738.7900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 193 236 247.637475 $12381.9400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 28 30 26.688889 $667.2200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 463 656 1775.364276 $88768.0800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 9 17.061310 $426.5300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 156 192 499.495229 $24974.7200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 6.566667 $164.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 65 92 231.480944 $11574.0200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 242 316 738.977766 $36948.8400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 20.102380 $502.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1358 1821 16662.416656 $833120.8700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 19 19 91.428570 $4571.4200 $50.0000
INTR -T1013 INTERPRETER 3 4 12.652381 $632.6200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 99 128 1121.723808 $80135.9300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 4 14.571428 $1040.9900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 32.714286 $1871.2500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 21.714286 $1242.0600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 65 87 810.704764 $57916.7500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 3 10.142856 $724.6100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 4.285714 $244.9700 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.600000 $729.6000 $456.0000
SENS -V5264 EARMOLD 3 3 4.411111 $79.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 236 293 2731.303962 $195124.3800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 8 35.428571 $2531.0200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 14.714286 $841.6600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 22 24 217.635713 $3020.7800 $13.8800
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Subtotal (Total Children Is Unduplicated) 1501 3988 25395.200496 $1397980.8500 $55.0500
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Total 4872 26488.165918 $1440412.1000 $54.3800
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Number of Children (Unduplicated) With at Least One Authorization 1553