Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4853 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 2 2 2.577778 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.059525 $2.2000 $36.9800
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Subtotal (Total Children Is Unduplicated) 3 3 2.637303 $2.2000 $0.8300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 5.366667 $260.2800 $48.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.172222 $8.0600 $46.7900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.344444 $41.1900 $119.5800
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 33 35 17.875398 $912.5400 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 119 136 63.011611 $3216.8100 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 47 54 15.822225 $807.7400 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 119 130 154.210950 $7872.5400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 2 0.505555 $25.8100 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 109 120 75.774616 $3868.3600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 13 13 3.731746 $190.5100 $51.0500
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Subtotal (Total Children Is Unduplicated) 321 500 336.815434 $17203.8400 $51.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.002740 $13.5000 $4927.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.033333 $51.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 101 55.932549 $2796.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 21 13.666669 $683.3500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1 1 0.133333 $6.6700 $49.9900
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 13.000000 $325.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 156 239 1551.142853 $38778.5800 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 7.142857 $357.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1238 1609 12181.388620 $609069.5400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1196 1605 12607.421537 $126074.2400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 199 244 1604.792855 $114646.4400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 16 17 140.865079 $8057.4700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 180 234 1690.648411 $120779.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 17 18 123.357142 $7051.1000 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.344444 $81.6600 $237.0900
SENS -V5264 EARMOLD 1 1 0.344444 $6.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 179 238 1365.493653 $97550.9000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 20.071429 $1148.0800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 11 12 73.676190 $1022.6200 $13.8800
TRAV -TRAVS Travel by mile 2 2 8.000000 $3.5600 $0.4500
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Subtotal (Total Children Is Unduplicated) 1528 4350 31458.458138 $1128504.3100 $35.8700
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Total 4853 31797.910875 $1145710.3600 $36.0300
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Number of Children (Unduplicated) With at Least One Authorization 1529