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: 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 2281 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 1.000000 $37.0000 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 3 3 1.400000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 13 14 45.341269 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 18 47.741269 $37.0000 $0.7800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.327778 $15.9000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 8.785714 $192.8500 $21.9500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.366667 $9.3600 $25.5300
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.277778 $33.2200 $119.6100
EXIT -EXIT EXIT ASSESSMENT 6 6 125.238096 $6261.9100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 19 19 9.449998 $708.7400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 40 41 19.683331 $1476.2300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.216667 $16.2500 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 11 14.347619 $1076.0700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 51 53 35.797617 $1986.7600 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 1.511111 $83.8700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.011111 $0.8300 $74.9300
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Subtotal (Total Children Is Unduplicated) 78 141 216.013487 $11861.9800 $54.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 7 4.366667 $21833.5000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.244444 $62.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 19 19 6.205556 $310.2800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 2.077778 $497.0100 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 46 57 142.904764 $7145.2500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 3.309524 $82.7400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 300 430 631.032537 $31551.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 24 33 26.911108 $672.7700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 5.533334 $276.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 3.133334 $156.6700 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 5.400000 $395.9300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 5 12.685713 $317.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 62 70 445.023017 $22251.1300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 834 1480 7715.591265 $77155.9300 $10.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 1.511111 $716.6200 $474.2400
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Subtotal (Total Children Is Unduplicated) 837 2122 9006.930152 $163425.4800 $18.1400
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Total 2281 9270.684908 $175324.4600 $18.9100
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Number of Children (Unduplicated) With at Least One Authorization 843