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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5047 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 69 76 180.938101 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 69 76 180.938101 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 3.066666 $172.0400 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 6 1.511110 $29.4800 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 6 7 2.511110 $59.4400 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 7 2.022221 $29.6800 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 7 2.022221 $17.8100 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 7 2.022221 $58.4800 $28.9200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.455555 $6.2900 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 5 1.566666 $32.9600 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 5 6 1.599999 $139.1000 $86.9300
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 0.422222 $31.7200 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.033333 $1.5100 $45.2800
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.033333 $3.8600 $115.7000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 5 39.285715 $1964.2900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 26 30 142.371430 $7118.5900 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $154.2300 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 53 67 619.638094 $31855.6000 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 2 13.142857 $675.6800 $51.4100
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Subtotal (Total Children Is Unduplicated) 95 161 836.704753 $42453.5700 $50.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 9 7.049999 $35249.5000 $4999.9300
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.033333 $7.7100 $231.3900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 226 320 432.206647 $21610.3500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 172 238 257.090971 $6427.2800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 291 319 296.963493 $14848.1700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 168 175 188.835715 $9441.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 111 116 113.893648 $5694.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 -0.872223 $-21.8100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 201 217 197.515874 $9875.8000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.094444 $27.3600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 39.428571 $1971.4400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1643 2235 17967.100014 $898355.6600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 229 300 2286.910318 $164566.1900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 228 301 2627.657933 $189086.4500 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 6 1.988888 $228.3300 $114.8000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.033333 $7.6500 $229.3800
SENS -V5264 EARMOLD 5 6 1.988888 $36.0600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 422 558 4653.230958 $334846.7000 $71.9600
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Subtotal (Total Children Is Unduplicated) 2004 4810 29085.293661 $1693205.0200 $58.2200
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Total 5047 30102.936515 $1735658.6000 $57.6600
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Number of Children (Unduplicated) With at Least One Authorization 2062