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 1084 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 58 68 182.146032 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 58 68 182.146032 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.516667 $29.5900 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.516667 $35.9000 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.516667 $22.2700 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.516667 $13.3600 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.516667 $43.8600 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.516667 $31.9100 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.505556 $30.8400 $61.0100
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.011111 $87.9100 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.011111 $45.8200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.011111 $117.1000 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 13.000000 $650.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 8 65.280953 $3264.0500 $50.0000
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Subtotal (Total Children Is Unduplicated) 11 25 90.919844 $4372.6100 $48.0900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 97 153 227.527778 $11376.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 19 24 25.250000 $631.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 169 183 170.176188 $8508.8000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.227778 $5.7000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 100 106 102.628571 $5131.4300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 57 60 49.222223 $2461.1200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 130 141 126.399998 $6319.9900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 177 225 1600.609525 $80030.4400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 26 30 248.990474 $17917.3700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 14 19 132.711903 $9549.9600 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.011111 $232.1600 $229.6100
SENS -V5264 EARMOLD 2 2 1.516667 $27.5000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 41 46 344.380957 $24781.6300 $71.9600
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Subtotal (Total Children Is Unduplicated) 448 991 3030.653173 $166973.7400 $55.0900
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Total 1084 3303.719049 $171346.3400 $51.8600
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Number of Children (Unduplicated) With at Least One Authorization 508