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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5745 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 15 16 16.907144 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 16 16.907144 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 175 259 211.046027 $10235.7100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 47 52 43.183180 $2422.5700 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 7 3.544445 $69.1500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.055556 $24.9900 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 2.627778 $38.5800 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 62 68 50.838883 $1122.0000 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 5 2.833333 $20.4000 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 2.000000 $57.8400 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 5.055556 $227.9100 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 5 3.783333 $52.2500 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 9 7.011111 $147.5100 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 1.511111 $131.3800 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 32 36 30.344444 $1375.2100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 3 0.472223 $54.7000 $115.8300
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
SCREEN-T1023 SCREENING 2 2 1.533333 $76.6700 $50.0000
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Subtotal (Total Children Is Unduplicated) 291 464 368.840313 $16156.8500 $43.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 57 70 108.603174 $543015.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 6 17.303968 $865.2000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 8 9 7.749999 $1795.0300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 284 376 273.334917 $13666.7200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 29 31 27.416667 $1370.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 104 130 142.465867 $7123.2700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 0.722222 $36.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.022222 $25.5600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 249 287 303.363480 $15168.1100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 7 7 10.677778 $533.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 8.243651 $206.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 139 166 172.126984 $8606.3500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 3 3 0.766667 $38.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 363 437 399.667432 $19983.2300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 4 5 5.166667 $258.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.161111 $29.0300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 14 14 102.019047 $5100.9400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 635 822 4811.746039 $240587.3800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 62 70 476.231745 $23811.5900 $50.0000
INTR -T1013 INTERPRETER 1 2 12.428572 $621.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1027 2319 9064.950741 $90649.4600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 72 86 542.649203 $39049.0300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 11 13 87.107936 $6268.2900 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 51 55 341.825396 $24597.7600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 20.685714 $1488.5400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 80 93 519.265079 $37366.3000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 7 7 31.680952 $2279.7600 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 52 66 308.987301 $22234.7200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 26.476190 $1905.2300 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 1.366666 $156.9000 $114.8000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 7 7.050000 $3237.5000 $459.2200
SENS -V5264 EARMOLD 9 11 18.261110 $331.0700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 70 90 615.938888 $44322.9600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 17.761905 $1278.1500 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 51 58 412.685713 $29696.8500 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 22.685715 $1632.4600 $71.9600
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Subtotal (Total Children Is Unduplicated) 1070 5265 18921.596718 $1189337.8900 $62.8600
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Total 5745 19307.344175 $1205494.7400 $62.4400
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Number of Children (Unduplicated) With at Least One Authorization 1084