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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5150 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 60 71 183.977778 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 60 71 183.977778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 2.133333 $119.6800 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 6 8 3.405555 $66.4400 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 7 10 4.466666 $105.7200 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 10 4.466666 $65.5700 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 10 4.466666 $39.3500 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 10 4.466666 $129.1700 $28.9200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.433333 $5.9800 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 9 4.033333 $84.8600 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.505556 $30.8400 $61.0100
AUDE -92651 AEP HEARING STATUS DETER I&R 6 9 3.022221 $262.7400 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 5 2.577777 $116.8200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 1.583333 $183.3600 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 7 7 45.190476 $2259.5200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 28 32 181.528571 $9076.4200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 3.428571 $176.2600 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 23 30 337.766667 $17364.5900 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 68 153 607.475390 $30292.9800 $49.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 5.961112 $29806.0000 $5000.0700
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.433333 $100.3600 $231.6000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 208 308 432.382238 $21619.1300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 163 223 226.169033 $5654.2300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 258 282 240.892853 $12044.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 3 0.588889 $14.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 163 174 154.684127 $7734.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.505556 $12.6400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 101 106 87.516667 $4375.8400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.477778 $11.9500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 194 216 180.705557 $9035.2900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 9 4.077778 $101.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1636 2207 17616.495230 $880824.8200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 253 345 2544.776978 $183122.1900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.000000 $935.4800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 241 334 2720.057926 $195735.3800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 3 37.000001 $2662.5200 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 4 1.405555 $161.3700 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 4 5 2.577777 $591.8700 $229.6000
SENS -V5264 EARMOLD 6 9 4.033333 $73.1200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 515 685 5657.611903 $407121.7400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.142857 $82.2400 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2068 4926 29932.496481 $1761821.6400 $58.8600
-------------------------------------------------------------------------------------------------------------------------------------
Total 5150 30723.949649 $1792114.6300 $58.3300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 2109