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: 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 4540 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 13 13 31.935716 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 15.571429 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 15 47.507145 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 93 116 148.454762 $7200.0600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 3.249315 $183.5500 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.900000 $26.3500 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.900000 $17.2500 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.900000 $52.8800 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 6 4.583334 $388.8600 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 2.155556 $48.2900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 6 3.850000 $173.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.088889 $125.2200 $115.0000
EXIT -EXIT EXIT ASSESSMENT 77 82 119.711947 $5985.5900 $50.0000
SCREEN-T1023 SCREENING 2 3 1.455555 $72.7800 $50.0000
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.944444 $47.2200 $50.0000
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Subtotal (Total Children Is Unduplicated) 178 228 291.193802 $14321.2900 $49.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 27 30 44.155555 $220777.5000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 2.866667 $143.3400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 3 0.755556 $54.1100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 8 9 6.033333 $1387.6600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 172 211 166.629177 $8331.5100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 10 11 10.666667 $533.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 8.000000 $200.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 144 181 230.455559 $11522.8000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 5 6 9.394444 $469.7200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 241 270 279.337303 $13966.8700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 13 15 8.344443 $417.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 3.280555 $82.0100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 193 223 206.392463 $10319.6400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 4 4 1.994444 $99.7200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 352 425 370.126983 $18506.3500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 11 12 8.000000 $400.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 11 11.588887 $289.7200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 0.238889 $11.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 106 132 909.965877 $45498.3000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 8 55.457143 $2772.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1127 2626 10697.538083 $106975.3800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 24 26 164.257937 $11734.5800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 4.022222 $287.3500 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 10.266667 $733.4500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 24 32 182.010319 $13002.8200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 6.733334 $481.0300 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 0.188889 $13.5000 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 2.022222 $922.1200 $456.0000
SENS -V5264 EARMOLD 5 6 4.000000 $72.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 28 138.510318 $9895.1800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 5.044444 $360.3700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 11.142857 $796.0500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.000000 $180.4400 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.571429 $21.1400 $37.0000
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Subtotal (Total Children Is Unduplicated) 1128 4297 13572.992666 $481259.9900 $35.4600
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Total 4540 13911.693613 $495581.2900 $35.6200
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Number of Children (Unduplicated) With at Least One Authorization 1137