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 3062 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 154 205 130.787436 $6343.1600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 1.833333 $102.1300 $55.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.666667 $15.6700 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.588889 $23.1700 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.144444 $3.3900 $23.4900
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.588889 $15.5600 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.588889 $45.6300 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.144444 $6.4600 $44.7500
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 3.472222 $294.5800 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $20.8900 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 7 13.489683 $607.0400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.355556 $40.8900 $115.0100
EXIT -EXIT EXIT ASSESSMENT 4 4 5.000000 $250.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 174 236 161.660452 $7768.5800 $48.0500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 24 28 47.361111 $236805.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.155556 $7.7800 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 10 10 14.434921 $721.7500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 0.688889 $47.4400 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 11 12 4.827777 $1110.3700 $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 39 41 273.738887 $13686.9600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 51 60 429.573017 $21478.6700 $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 8 10 50.598412 $3614.7500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 7 7 24.365078 $1740.6400 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 3.200000 $228.6100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 9 9 45.795238 $3271.6100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 15 17 77.233333 $5517.5400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 4 4 8.711111 $622.3200 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 8 8 27.144445 $1939.2000 $71.4400
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.955556 $217.8800 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 4 2.677777 $1221.0300 $455.9900
SENS -V5264 EARMOLD 5 6 5.611112 $101.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 23 92.969050 $6641.7100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 9 31.108731 $2222.4100 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.533333 $109.5400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 14 14 100.596031 $7186.5800 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 2.333333 $86.3300 $37.0000
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Subtotal (Total Children Is Unduplicated) 867 2807 6065.303705 $416529.8800 $68.6700
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Total 3062 6262.264157 $424298.4600 $67.7500
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Number of Children (Unduplicated) With at Least One Authorization 885