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: 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 5194 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 8 3.988889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 8 3.988889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 17 18 8.616668 $417.9100 $48.5000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.626027 $131.3000 $50.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.142857 $57.1500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 10 13 3.211111 $163.9300 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 185 213 150.408723 $7678.3300 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 13 15 5.244444 $267.7300 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 177 217 151.580151 $7738.1400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.500000 $25.5300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 131 157 123.447298 $6301.9500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 5 5 0.866666 $44.2400 $51.0500
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Subtotal (Total Children Is Unduplicated) 417 643 447.643945 $22826.2000 $50.9900
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 4 1.761111 $88.0600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.883333 $63.2500 $71.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 54 175 50.455540 $2522.7000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 11 14.319678 $715.9800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 3.877777 $193.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 10 20.877779 $1043.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7 7 28.558730 $1427.9400 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 179 255 1985.285704 $49632.2100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1277 1630 13825.163110 $691258.6400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1243 1630 13535.172963 $135351.8100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 230 286 1934.072231 $138170.1100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 5 42.857144 $2451.4300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 210 271 1991.785728 $142293.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 7 37.142859 $2123.0800 $57.1600
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 1 2 0.700000 $331.9700 $474.2400
SENS -V5264 EARMOLD 1 2 0.700000 $12.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 192 241 1452.006368 $103731.3000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 11.000000 $629.2000 $57.2000
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Subtotal (Total Children Is Unduplicated) 1584 4543 34936.620055 $1272041.2300 $36.4100
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Total 5194 35388.252889 $1294867.4300 $36.5900
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Number of Children (Unduplicated) With at Least One Authorization 1587