Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4906 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 7 7 7.899999 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 7 7 7.899999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 60 79 24.791398 $1202.4400 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.079452 $1.1900 $14.9400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.079452 $0.8300 $10.4300
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 0.334246 $7.3400 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.079452 $0.7000 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.079452 $1.7400 $21.8500
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.079452 $1.8200 $22.9100
EVAL -96111 DEVELOPMENTAL EVALUATION 5 5 2.761643 $138.0800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 99 101 67.127247 $3356.3800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 0.016437 $1.2400 $75.2900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.010958 $0.8300 $75.2900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 1.005479 $55.8100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 29 30 23.594515 $1769.6100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 8 8 4.032874 $302.4800 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 34 35 30.104104 $1670.7900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 15 15 10.047945 $753.6000 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.230137 $11.7500 $51.0400
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 12 12 4.330290 $221.0700 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 3 0.011036 $0.5600 $50.8800
PSTH -97001 EVAL BY LICENSED PT, INITIAL 13 13 3.056089 $156.0200 $51.0500
SCREEN-T1023 SCREENING 14 21 6.351675 $317.5900 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.252055 $12.8700 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 12 12 6.590108 $336.4300 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 240 351 185.045496 $10321.1400 $55.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 27 8.026790 $40136.0000 $5000.2600
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.079452 $3.9800 $50.0300
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.076712 $18.3500 $239.1600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 82 100 49.842255 $2492.1000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 15 18.975284 $474.3800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 422 600 1312.071018 $65603.8600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 16 21 56.700001 $1417.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 108 150 312.113105 $15605.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 7 15.433334 $385.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 77 94 209.982620 $10499.1800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 6.944445 $173.6100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 323 388 834.599668 $41730.2000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 11 13 28.994447 $724.8700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 55.714285 $1392.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 95 127 907.613494 $45380.7000 $50.0000
INTR -T1013 INTERPRETER 16 23 120.742205 $6037.1100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 590 1151 6348.880168 $63488.8600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 39 53 447.665078 $31981.2100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 48 64 591.342530 $42245.5500 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 93 115 1116.733006 $79779.4600 $71.4400
TRAV -TRAVS Travel by mile 672 1592 389021.623660 $173114.6300 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 702 4548 401464.153557 $622685.9300 $1.5500
-------------------------------------------------------------------------------------------------------------------------------------
Total 4906 401657.099052 $633007.0700 $1.5800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 718