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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1380 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 79 95 199.025404 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 79 95 199.025404 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 1.772222 $41.6500 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 5 2.283333 $53.6600 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 1.966666 $28.6700 $14.5800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 1.966666 $19.2500 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 1.966666 $56.4800 $28.7200
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.705555 $144.6900 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 1.966666 $26.9600 $13.7100
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.261111 $11.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.261111 $30.0300 $115.0000
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Subtotal (Total Children Is Unduplicated) 4 29 14.149996 $413.1400 $29.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 2.403968 $12020.0000 $5000.0700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 93 150 243.505480 $12175.2700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 23 33 38.000000 $950.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 162 171 191.206348 $9560.3200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 3.900000 $97.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 127 131 132.212699 $6610.6400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.000000 $50.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 68 73 82.890477 $4144.5300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 147 156 158.177779 $7908.9000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 2.233333 $55.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 240 265 2166.246039 $108312.3800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 38 48 372.942856 $26643.0700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 47 58 432.476189 $30896.1300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 13.142857 $938.9300 $71.4400
SENS -V5264 EARMOLD 3 3 1.705555 $30.7000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 131 156 1316.307935 $94037.1100 $71.4400
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Subtotal (Total Children Is Unduplicated) 643 1256 5159.351515 $314431.2900 $60.9400
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Total 1380 5372.526915 $314844.4300 $58.6000
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Number of Children (Unduplicated) With at Least One Authorization 710