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: 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 4606 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 19 19 35.300000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 19 35.300000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 161 215 140.065214 $6793.1300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 23 26 21.916666 $1220.9700 $55.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.666667 $15.6700 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 5 3.344444 $48.7600 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 12 12 6.499999 $152.7500 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 5 3.344444 $32.7400 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 5 3.344444 $96.0500 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.166666 $52.2200 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 23 23 15.161111 $1286.2700 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 4 2.511111 $34.4300 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 10 8.105555 $169.3200 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 21 25 28.011905 $1260.5400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 4.055556 $466.3900 $115.0000
EXIT -EXIT EXIT ASSESSMENT 5 5 6.000000 $300.0000 $50.0000
SCREEN-T1023 SCREENING 3 3 2.411112 $120.5600 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.177778 $9.0800 $51.0600
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.177778 $9.0800 $51.0600
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Subtotal (Total Children Is Unduplicated) 242 349 246.960450 $12067.9600 $48.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 39 47 58.085387 $290426.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.922223 $46.1200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 12 13 16.479365 $823.9700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 10 10 3.180517 $219.0000 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 24 27 11.894443 $2735.6900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 164 214 151.358525 $7567.9100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 130 171 127.077782 $6353.9100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 84 104 142.203166 $7110.1200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 89 121 194.099993 $9704.9700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.888889 $22.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 154 177 156.303956 $7815.1500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 133 151 157.831740 $7891.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 2.688889 $67.2200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 74 85 103.164287 $5158.2200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 53 57 53.305557 $2665.2900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 182 203 201.753167 $10087.6100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 170 198 192.928565 $9646.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 6.399999 $160.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 269 317 1643.032528 $82151.6600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 522 644 3752.043858 $187602.2800 $50.0000
INTR -T1013 INTERPRETER 1 2 10.071429 $503.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 547 1043 3319.615063 $33196.1600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 61 80 379.880154 $27138.6300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 31 36 178.273808 $12735.8900 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 6 8 38.285714 $2735.1400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 79 90 512.776182 $36632.7500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 54 72 272.686510 $19480.7300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 20 25 106.677776 $7621.0600 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 13 15 58.678571 $4192.0000 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 56 76 307.568251 $21972.6800 $71.4400
SENS -V5060 BEHIND EAR HEARING AID 2 3 1.977778 $450.9400 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 8 6.477777 $2953.8300 $455.9900
SENS -V5264 EARMOLD 11 13 12.488889 $224.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 69 82 317.184923 $22659.6800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 19 27 113.242064 $8090.0100 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 9 11 28.776190 $2055.7700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 78 93 563.563487 $40260.9600 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 10.000000 $138.8000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 2.333333 $86.3300 $37.0000
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Subtotal (Total Children Is Unduplicated) 1001 4238 13216.200735 $881385.4800 $66.6900
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Total 4606 13498.461185 $893453.4400 $66.1900
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Number of Children (Unduplicated) With at Least One Authorization 1013