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 1023 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
----------------------------------------------------------------------------
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 1 1 0.511111 $10.0700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.511111 $12.0100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.511111 $7.0900 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.511111 $4.6400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.511111 $14.2200 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.511111 $43.3600 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.511111 $8.5400 $16.7000
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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1 9 4.599999 $181.7100 $39.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 4 3.511111 $17555.5000 $4999.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 64 104 160.074428 $8003.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 28 37 39.288562 $982.2200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 73 79 130.371897 $6518.6000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.155556 $3.8900 $25.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 69 72 87.145706 $4357.3000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 42 58.090476 $2904.5200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 88 92 133.215874 $6660.8000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.155556 $53.8900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 219 243 2030.485705 $101524.4300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 64.285714 $3214.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 43 52 414.609521 $29619.7500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.066667 $219.0900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 35 38 388.771424 $27773.8700 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.511111 $116.5300 $228.0000
SENS -V5264 EARMOLD 1 1 0.511111 $9.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 130 153 1307.895234 $93436.1700 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 496 928 4825.145653 $302978.7500 $62.7900
-------------------------------------------------------------------------------------------------------------------------------------
Total 1023 5034.732957 $303233.2200 $60.2300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 571