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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4284 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 18 18 17.577778 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 9.666666 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 20 20 27.244444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 8 8 8.044444 $831.4700 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 203 263 224.045231 $10866.1700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 34 35 29.896499 $1677.1900 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 9 10 6.022222 $95.3900 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 2 1.022222 $19.9400 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 3 1.511111 $35.7700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 5 2.533333 $37.1900 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 60 65 58.999995 $1302.1200 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 5 2.005555 $17.6700 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 3 1.511111 $43.7000 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 3 1.511111 $68.1200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 5 1.733333 $23.9400 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 4 1.983333 $41.7300 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.472222 $28.8000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 4 5 3.244444 $282.0700 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 2 1.494444 $112.2700 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 40 44 32.527777 $1474.1600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 1.555555 $180.1400 $115.8100
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Subtotal (Total Children Is Unduplicated) 316 467 380.113942 $17137.8400 $45.0900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 14 15 10.811112 $458.5000 $42.4100
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.011111 $42.8800 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 75 90 113.661106 $568303.0000 $4999.9800
AUDE -V5160 DISPENSING FEE BINAURAL 7 10 5.249999 $1215.9800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 273 360 254.353177 $12717.6800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 13 16 10.561111 $528.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 95 111 96.423809 $4821.1900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 212 232 329.434114 $16471.6500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 5 5 6.407935 $320.3900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 -0.505556 $-12.6400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 150 184 171.269032 $8563.3800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 329 401 320.397587 $16019.7300 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 3 0.266666 $13.3300 $49.9900
CONSP -CONSP CONSULT, SLP, PHONE 9 11 8.150001 $203.7500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 10 61.588890 $1539.7300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 10 10 58.899999 $2945.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 646 843 4736.906360 $236845.3900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 41 52 253.260317 $12663.0200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 469 933 3078.122993 $36937.4700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 97 127 747.038098 $53756.8900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 13 15 121.549206 $8746.6900 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 63 91 435.885721 $31366.3300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 55 65 268.997618 $19357.0600 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 7 7 38.949208 $2802.7900 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 41 49 259.987301 $18708.7200 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 4 2.244444 $257.6800 $114.8100
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.533333 $122.4500 $229.6000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 7 5.811110 $2668.5300 $459.2100
SENS -V5264 EARMOLD 10 13 21.299997 $386.1600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 68 88 526.652377 $37897.9400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 50.200000 $3612.4000 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 30 33 140.182539 $10087.5400 $71.9600
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Subtotal (Total Children Is Unduplicated) 1020 3797 12136.600715 $1110393.6500 $91.4900
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Total 4284 12543.959101 $1127531.4900 $89.8900
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Number of Children (Unduplicated) With at Least One Authorization 1033