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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4809 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 56 61 150.180953 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 56 61 150.180953 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 4 2.022222 $39.4500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 7 3.927778 $92.9700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 7 3.927778 $57.6600 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 7 3.927778 $28.2800 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 7 3.927778 $113.5900 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 6 2.927778 $61.6000 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 2 2 1.511111 $92.1800 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 3 5 2.416667 $210.1100 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 2.905556 $131.6800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.450000 $167.9200 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 9.714286 $485.7200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 28 30 168.852381 $8442.6300 $50.0000
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 36 84 208.511113 $9975.2000 $47.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 4.833333 $24166.5000 $4999.9700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 206 304 426.411363 $21320.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 146 203 234.970637 $5874.2700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 170 190 236.820309 $11841.0300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 5 0.772147 $19.3000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 143 152 155.673016 $7783.6500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 80 85 90.183007 $4509.1500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.450000 $11.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 170 184 234.831746 $11741.5900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 2.566667 $64.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 8 44.766667 $2238.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1525 2016 16738.319012 $836916.4900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 13.142857 $657.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 257 340 2796.171430 $201212.5700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 36.000000 $2590.5700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 251 331 2856.572622 $205559.1400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 6 78.857143 $5674.5700 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 1.511111 $173.4900 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 3 4 2.394445 $549.8000 $229.6200
SENS -V5264 EARMOLD 5 7 3.927778 $71.2100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 609 797 6813.871423 $490326.5000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 8 10 87.857142 $6322.2100 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $945.7600 $71.9600
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Subtotal (Total Children Is Unduplicated) 2024 4664 30877.046712 $1840694.2700 $59.6100
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Total 4809 31235.738778 $1850669.4700 $59.2500
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Number of Children (Unduplicated) With at Least One Authorization 2062