Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 6252 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 7 7 5.888888 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 13.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 18.888888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 96 119 121.783338 $5906.5100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 20 21 17.802054 $1005.6400 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 5 3.588889 $49.7800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 20 20 11.733337 $278.0900 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 5 3.588889 $32.5900 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 5 3.588889 $99.8800 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 21 25 25.511111 $2164.3600 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 4.538889 $101.6700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 29 31 25.805556 $1161.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 3.033333 $348.8300 $115.0000
EXIT -EXIT EXIT ASSESSMENT 115 127 196.004032 $9800.2000 $50.0000
SCREEN-T1023 SCREENING 25 27 21.655555 $1082.7800 $50.0000
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.088889 $3.2000 $35.9800
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Subtotal (Total Children Is Unduplicated) 300 395 438.722761 $22034.7800 $50.2200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 60 79 109.736836 $548685.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.011111 $50.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 8 9 5.288051 $264.4000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 4.666667 $334.1800 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 7 3.844446 $275.3100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 17 19 11.355556 $2611.7900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 187 221 189.407903 $9470.4800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 4.255556 $106.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 142 177 193.130157 $9656.5000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 246 286 282.636126 $14131.7800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 0.930556 $23.2700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 197 235 233.558334 $11677.9200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 348 423 372.615088 $18630.8000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 11 12.177779 $304.4500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 817 1083 7327.794432 $366389.6900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 35 36 91.946032 $4597.3100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1137 2747 11279.838922 $112798.3900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 127 171 1075.769046 $76852.9200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 8.714286 $622.5500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 5 33.911111 $1939.7100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 1.000000 $57.2000 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.857143 $61.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 101 128 750.711905 $53630.8800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 8 8 7.666667 $547.7100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 6 27.583334 $1576.6700 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 7 4.333334 $1976.0300 $456.0100
SENS -V5264 EARMOLD 11 14 10.133333 $182.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 118 148 797.421425 $56967.7900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 6.266667 $447.6900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 9.355556 $535.1400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 0.714286 $51.0300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 48.228572 $669.4100 $13.8800
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Subtotal (Total Children Is Unduplicated) 1140 5849 22906.860217 $1296126.5600 $56.5800
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Total 6252 23364.471866 $1318161.3400 $56.4200
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Number of Children (Unduplicated) With at Least One Authorization 1148