Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 07-01-16 and 09-30-16 Date of Report: 10-26-16 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2449 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 0.266667 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 12 13 66.911905 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 15 67.178572 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.744444 $7.7600 $10.4200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.511111 $61.1300 $119.6000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.677778 $133.8900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 8 8 6.972222 $348.6100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 3.488889 $261.6700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 26 26 11.672222 $875.4200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.405556 $30.4200 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 8 1.666667 $125.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 37 37 17.455554 $968.7700 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 54 97 52.594443 $3233.1600 $61.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 8 4.231050 $21155.0000 $4999.9400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 1.538888 $76.9400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 54 54 25.243953 $1262.1800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 6.221429 $445.5100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 1.527778 $365.4500 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 60 65 319.373812 $15968.7000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 3.022222 $75.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 330 498 764.146820 $38207.3200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 33 46 54.955552 $1373.8800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 4.416667 $323.8300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 15.304762 $382.6200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 52 64 350.357932 $17517.9100 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 813 1579 7790.470611 $77904.7500 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.311111 $20.2200 $65.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 1.261111 $598.0600 $474.2400
TRAV -TRAVS Travel by mile 1 1 3.642857 $1.6200 $0.4500
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Subtotal (Total Children Is Unduplicated) 817 2337 9348.026555 $175779.5400 $18.8000
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Total 2449 9467.799570 $179012.7000 $18.9100
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Number of Children (Unduplicated) With at Least One Authorization 821