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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 13169 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 38 42 74.307935 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.533333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 39 43 74.841268 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 3 7.000000 $723.5200 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 348 587 597.485708 $28978.0300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 80 95 92.048707 $5163.9400 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 9 10 6.933333 $109.8200 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 8 9 8.561112 $167.0300 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 6 5.061111 $119.8000 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 11 13 10.427779 $153.0800 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 116 142 167.090478 $3687.6900 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 10 12 11.011111 $97.0100 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 8 7.161112 $207.1000 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 7 8.061111 $363.3900 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 7 11 11.416666 $157.6600 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 18 20 14.594445 $307.0700 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.872222 $53.2000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 5 5 4.194444 $364.6600 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 3 3 13.105555 $984.6200 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 54 66 61.949998 $2807.5700 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 5 2.522222 $292.1000 $115.8100
EXIT -EXIT EXIT ASSESSMENT 4 4 6.000000 $300.0000 $50.0000
SCREEN-T1023 SCREENING 3 3 2.844445 $142.2300 $50.0000
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Subtotal (Total Children Is Unduplicated) 555 1010 1038.341559 $45179.5100 $43.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 134 180 287.335713 $1436678.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 9 9 34.269047 $1713.4500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.197260 $83.0300 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 21 26 24.205555 $5606.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 683 1102 983.326597 $49166.3700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 88 127 97.833336 $4891.6800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 203 285 610.490468 $30524.4800 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 22 25 58.444443 $2922.2200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 4.900000 $122.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 453 597 1079.258726 $53962.9100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 40 43 70.265874 $3513.3000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 11 12 37.543649 $938.5900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 242 350 629.751582 $31487.5500 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 18 19 17.707144 $885.3600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 636 927 1592.991267 $79649.5400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 46 49 43.323019 $2166.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 15 17 15.688890 $392.2300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.077778 $1.9500 $25.0100
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 28 30 248.009525 $12400.4800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1104 1846 19653.874591 $982693.7200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 212 268 2070.923022 $103546.1400 $50.0000
INTR -T1013 INTERPRETER 1 2 25.571429 $1278.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1692 5038 35987.953912 $431855.4000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 126 182 2022.234125 $145520.0200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 23 32 350.553968 $25225.8500 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 91 126 1397.503968 $100564.3600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 15 16 89.785713 $6460.9800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 135 196 2048.025387 $147375.8700 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 10 11 99.693651 $7173.9500 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 94 143 1336.926193 $96205.2000 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 18 21 121.278572 $8727.2100 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 3 4.855556 $557.4700 $114.8100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 12 16 24.100000 $11067.2000 $459.2200
SENS -V5264 EARMOLD 17 27 79.588889 $1442.9500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 140 220 2225.488889 $160146.2100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 11 68.738096 $4946.3900 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 96 140 1622.979364 $116789.5900 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 10 13 118.671429 $8539.5900 $71.9600
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Subtotal (Total Children Is Unduplicated) 1768 12116 75186.366627 $4077292.2800 $54.2300
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Total 13169 76299.549454 $4122471.8000 $54.0300
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Number of Children (Unduplicated) With at Least One Authorization 1790