Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 1288 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 67 81 176.234919 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 67 81 176.234919 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.255555 $5.0400 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 0.255555 $6.0000 $23.4800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.255555 $17.4100 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.255555 $11.4000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 1.255555 $34.9400 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 0.255555 $21.6800 $84.8200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 0.761111 $12.7100 $16.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.083333 $3.7500 $44.9800
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.083333 $9.5800 $114.9500
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 27.000000 $1350.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 15.242856 $762.1400 $50.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 11 28 49.703963 $2336.7500 $47.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 3.000000 $15000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 102 152 201.592937 $10079.6400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 64 74 62.743020 $1568.5800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 69 74 83.253967 $4162.7000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 52 53 75.783334 $3789.1700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 48 50 65.346032 $3267.3100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 86 92 139.419047 $6970.9500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 318 386 2878.062702 $143903.0800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 6 6 14.571428 $728.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 40 48 358.857143 $25636.7800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 1.914286 $136.7600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 42 49 399.366663 $28530.7600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 0.200000 $14.2900 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.083333 $18.9900 $227.9100
SENS -V5264 EARMOLD 3 3 1.266666 $22.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 150 182 1466.578114 $104772.3600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.857143 $61.2300 $71.4400
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Subtotal (Total Children Is Unduplicated) 641 1179 5754.895815 $348713.9500 $60.5900
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Total 1288 5980.834697 $351050.7000 $58.7000
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Number of Children (Unduplicated) With at Least One Authorization 709