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 4707 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 96 118 121.650005 $5900.0500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 3.095890 $174.8900 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.566667 $21.7300 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.566667 $14.2300 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.566667 $43.6000 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 5 3.188889 $270.5500 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 2.505556 $56.1300 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 5 3.066667 $138.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 2.022222 $232.5500 $115.0000
EXIT -EXIT EXIT ASSESSMENT 113 125 193.581810 $9679.0900 $50.0000
SCREEN-T1023 SCREENING 3 3 2.733333 $136.6700 $50.0000
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Subtotal (Total Children Is Unduplicated) 211 270 336.544373 $16667.4800 $49.5300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 36 41 73.677779 $368389.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 2.171385 $108.5700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 4 2.238890 $160.3300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 10 10 5.805556 $1335.2900 $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 117 150 1017.034920 $50851.7600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 8 17.800000 $890.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1137 2746 11268.838922 $112688.3900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 25 34 191.610318 $13688.6400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.714286 $122.4700 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.857143 $61.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 21 27 184.611904 $13188.6700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 0.466667 $33.3400 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 1.644445 $749.8900 $456.0200
SENS -V5264 EARMOLD 5 6 3.677778 $66.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 25 31 159.832540 $11418.4600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 4.714286 $65.4300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1137 4429 14225.408318 $637819.7400 $44.8400
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Total 4707 14580.841579 $654487.2200 $44.8900
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Number of Children (Unduplicated) With at Least One Authorization 1143