Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 1827 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 10 10 232.224605 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 10 10 232.224605 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $22.9000 $22.9000
EXIT -EXIT EXIT ASSESSMENT 51 51 22.920702 $1146.0300 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.002740 $0.1500 $54.6700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 2.016437 $151.2400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 6.167123 $342.2700 $55.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 1.494444 $76.2900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 2 2 1.511111 $77.1400 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 12 13 18.686083 $953.9200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 5 6 2.577778 $131.6000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 82 88 59.376418 $3054.6800 $51.4500
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.066667 $3.3400 $50.0200
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 10 10 19.454904 $972.7500 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.966667 $231.2300 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 165 204 112.513139 $5625.7100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 6 8.611111 $215.2800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 378 758 2483.483034 $124174.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 16 32 92.285718 $2307.1500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 24 26 120.214290 $6010.7400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 6.133334 $153.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 12 42.390478 $2119.5400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 32 35 160.747621 $8037.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 6 14.752381 $368.8100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 324 451 3958.766657 $197938.5300 $50.0000
INTR -T1013 INTERPRETER 14 15 149.857142 $7492.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 2 12.571428 $125.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 8 83.428571 $5960.1500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 9 14 99.857142 $7133.8000 $71.4400
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 1 1 2.000000 $948.4800 $474.2400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 36 44 365.285715 $26096.0200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 16.285714 $226.0500 $13.8800
TRAV -TRAVS Travel by mile 65 98 744.052377 $331.1000 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 706 1729 8493.724090 $396472.3700 $46.6800
-------------------------------------------------------------------------------------------------------------------------------------
Total 1827 8785.325113 $399527.0500 $45.4800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 726