Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2580 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 35 40 37.396029 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.147222 $5.4500 $36.9900
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Subtotal (Total Children Is Unduplicated) 36 41 37.543251 $5.4500 $0.1500
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 6.000000 $338.9400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.288889 $25.4000 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 11 11 14.288889 $335.6500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 9 9 9.288889 $128.8400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 8 7.288889 $172.7500 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 10 10 8.572222 $77.8400 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 3 3.000000 $29.8800 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 13 13 10.572222 $294.2200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 7 7 8.288889 $318.8700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 10 10 24.571429 $2084.6400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 4.000000 $204.2800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 16 17 14.572222 $243.3600 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 12 12 21.926985 $491.1600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 7.000000 $315.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.283333 $32.5800 $114.9900
EXIT -EXIT EXIT ASSESSMENT 182 182 281.384521 $14069.2100 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 10 10 4.328766 $240.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 0.076712 $5.7500 $74.9900
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 9 8.105555 $413.7900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 5 2.227778 $113.7300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 6 5.044444 $257.5200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 16 16 12.916666 $659.3900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
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Subtotal (Total Children Is Unduplicated) 242 350 464.027300 $21299.4900 $45.9000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.016667 $83.5000 $5009.9000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 4.066667 $203.3400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 10.000000 $2300.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 171 238 222.406954 $11120.3800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 37 45 55.396830 $1384.9300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 526 664 2124.490503 $106224.6700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 2.833333 $141.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 9 17.533335 $438.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 235 291 744.976205 $37248.9000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 7.133334 $178.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 107 139 370.047625 $18502.4100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 7.570834 $189.2700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 281 341 986.470263 $49323.6500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 6 17.038095 $425.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 291 357 3488.038077 $174402.1000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 26.285714 $1314.2900 $50.0000
INTR -T1013 INTERPRETER 4 5 7.428571 $371.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 24 209.142854 $14941.1800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.285714 $20.4100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 13 14 176.142856 $12583.6600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.428571 $316.3800 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 33 285.776187 $20415.8700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 16.142857 $1153.2500 $71.4400
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Subtotal (Total Children Is Unduplicated) 778 2189 8783.652046 $453283.8900 $51.6100
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Total 2580 9285.222597 $474588.8300 $51.1100
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Number of Children (Unduplicated) With at Least One Authorization 885