Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 2242 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 54 56 66.776187 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.266667 $9.8700 $37.0000
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Subtotal (Total Children Is Unduplicated) 54 57 67.042854 $9.8700 $0.1500
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.252055 $11.8000 $46.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 1.966972 $235.2700 $119.6100
EVAL -96111 DEVELOPMENTAL EVALUATION 8 10 2.451063 $122.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 17 17 3.691780 $184.5900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 8 8 12.010958 $900.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 10.010958 $750.8300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 2.016437 $151.2400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 5 5 0.729985 $37.2700 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 14 15 1.325649 $67.6800 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 7 7 7.131931 $364.0800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 7 0.510731 $26.0800 $51.0700
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.136987 $6.9900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 11 12 1.998762 $102.0400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 0.076985 $3.9300 $51.0600
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Subtotal (Total Children Is Unduplicated) 82 106 48.322211 $3187.8800 $65.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 10 3.155328 $15776.5000 $4999.9600
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 28 15.991858 $799.6000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 21 30 42.000002 $1050.0100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 226 298 338.138099 $16906.9200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 247 332 1048.234131 $26205.9000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 83 139 149.465078 $7473.2600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 51 72 117.374603 $2934.3600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 36 58 48.003177 $2400.1700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 23 29 58.797616 $1469.9400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 176 219 265.111115 $13255.5700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 207 275 899.743654 $22493.6400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 5 47.714285 $1192.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 134 161 1179.873802 $58993.7500 $50.0000
INTR -T1013 INTERPRETER 4 4 25.857143 $1292.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 59 78 508.648412 $36337.8400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 33 40 306.428569 $17527.7300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 50 59 447.128969 $31942.9000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 19 25 139.250002 $7959.5300 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 0.504110 $119.5600 $237.1600
SENS -V5060 BEHIND EAR HEARING AID
2 2 1.252055 $296.9000 $237.1300
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 1 1 1.000000 $474.2400 $474.2400
SENS -V5264 EARMOLD 6 7 8.022221 $144.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 154 202 1391.959516 $99441.6700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.285714 $73.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 2.142857 $29.7400 $13.8800
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Subtotal (Total Children Is Unduplicated) 584 2079 7047.082316 $366593.3500 $52.0200
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Total 2242 7162.447381 $369791.1000 $51.6300
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Number of Children (Unduplicated) With at Least One Authorization 640