Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 4261 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 1 1 1.966667 $72.7700 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 76 85 203.020638 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 77 86 204.987305 $72.7700 $0.3500
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.677778 $13.3600 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 5 1.783333 $41.8900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 6 1.950000 $27.0500 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 6 1.950000 $17.7100 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 6 1.950000 $54.2700 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 6 1.950000 $165.4400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 2 0.511111 $26.1000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 1.438889 $24.0300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.250000 $5.6000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.511111 $23.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.511111 $58.7800 $115.0000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 4.285714 $321.4300 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 17 57.780956 $2889.0700 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 21 59 76.550003 $3718.7600 $48.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 8 5.677777 $28388.5000 $4999.9300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 161 226 316.176286 $15808.8200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 193 275 309.707636 $7742.7000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 108 123 165.966340 $8298.3200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 2.505556 $62.6400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 98 105 144.699912 $7235.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 61 68 84.890475 $4244.5200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.511111 $37.7800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 123 131 154.140984 $7707.0400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 6.994445 $174.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1189 1566 12441.895198 $622095.4000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 18 20 285.999997 $14300.0300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 267 341 2449.777762 $175012.3300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 7 7 58.971429 $4212.9400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 273 352 2980.134901 $212901.0800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 7 8 81.923809 $5852.6600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 2.285714 $130.6500 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.511111 $116.5300 $228.0000
SENS -V5264 EARMOLD 4 5 1.700000 $30.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 667 859 7423.769010 $530354.7300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 15.857143 $1132.8300 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 8.714286 $622.5500 $71.4400
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Subtotal (Total Children Is Unduplicated) 1802 4116 26944.810882 $1646487.4900 $61.1100
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Total 4261 27226.348190 $1650279.0200 $60.6100
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Number of Children (Unduplicated) With at Least One Authorization 1874