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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 8990 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 6.555556 $242.5600 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 108 124 562.998411 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 55 56 1336.193653 $49439.1700 $37.0000
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Subtotal (Total Children Is Unduplicated) 163 184 1905.747620 $49681.7200 $26.0700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 50 71 59.567278 $2889.0100 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 2 0.505556 $9.9700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 0.505556 $11.8800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 2 0.505556 $7.0100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 2 0.505556 $11.9800 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 4 0.754871 $6.8500 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 2 0.505556 $14.0700 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 0.505556 $19.4500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 2 0.249315 $21.1500 $84.8300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 3 1.249315 $63.8000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 2 0.505556 $8.4400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 4 0.754871 $16.9100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 4 0.754871 $33.9700 $45.0000
EXIT -EXIT EXIT ASSESSMENT 116 116 232.000000 $11600.0000 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 11.500000 $862.5000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 1.500000 $112.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 16 17 32.000000 $1776.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 20 30 57.000000 $4275.0000 $75.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 3.000000 $153.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 4.000000 $204.2000 $51.0500
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Subtotal (Total Children Is Unduplicated) 199 283 416.869413 $22709.9000 $54.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 9.216438 $46082.0000 $4999.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 9 12 7.765982 $388.3000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 5.000000 $1150.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 286 344 452.785702 $22639.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 4 4.000000 $200.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 174 195 184.233267 $4605.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 284 375 889.408722 $44470.4000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 3.033333 $151.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 11 18.066666 $451.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 120 149 300.511105 $15025.5300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 9 15.909524 $397.7400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 145 188 401.957926 $20097.8500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 11.809523 $295.2400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 238 314 629.246817 $31462.3100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 15.916667 $397.9200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 138 179 1478.188886 $73909.4500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 13.000000 $650.0000 $50.0000
INTR -T1013 INTERPRETER 114 135 859.496034 $42974.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1801 3252 22492.998368 $224929.9900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 16 129.876191 $9278.3400 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 7.000000 $500.0800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 11 17 139.142857 $9940.3700 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 29 38 249.323811 $17811.6700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 4 23.809524 $1700.9600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 4.285714 $59.4900 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 19.285714 $713.5700 $37.0000
TRAV -TRAVS Travel by mile 1799 3252 22527.084083 $10024.5500 $0.4400
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Subtotal (Total Children Is Unduplicated) 1834 8523 50892.352854 $580308.9800 $11.4000
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Total 8990 53214.969887 $652700.6100 $12.2700
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Number of Children (Unduplicated) With at Least One Authorization 1913