Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 8203 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 4 4 4.243651 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.022222 $37.8200 $37.0000
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Subtotal (Total Children Is Unduplicated) 5 5 5.265873 $37.8200 $7.1800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 25 28 11.972222 $779.8700 $65.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 4 2.044444 $95.6800 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 5 2.061111 $246.5100 $119.6000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.027778 $2.0900 $75.0600
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 6 6 9.000000 $499.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 6 6 7.027778 $527.0900 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 54 68 53.061901 $2708.8000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 200 232 115.658725 $5904.3500 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 71 85 52.210312 $2665.3200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 140 156 70.750790 $3611.8100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.650000 $33.1800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 400 477 254.073798 $12970.4200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 5 5 3.600000 $183.7800 $51.0500
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Subtotal (Total Children Is Unduplicated) 654 1077 585.138859 $30426.8800 $52.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 0.344445 $1722.5000 $5000.8000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 1.333333 $318.9300 $239.1900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 8 3.566667 $178.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 12 12 14.028571 $701.4300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 315 386 286.089658 $14304.3600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 71 85 56.683329 $2834.1500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 856 1039 748.257086 $37412.5700 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 127 150 1360.158728 $34003.9900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1139 1405 12118.568251 $605928.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1237 3145 14860.501502 $148605.0200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 186 230 1602.469856 $114480.4600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 12 12 75.671429 $4328.4000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 157 195 1364.109533 $97452.0000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 21 26 187.007940 $10689.3700 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 4 8.000000 $1896.9600 $237.1200
SENS -V5264 EARMOLD 2 4 2.044444 $36.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 252 314 2225.918659 $159019.6500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 18.000001 $1029.5900 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 67.142858 $931.9500 $13.8800
TRAV -TRAVS Travel by mile 64 86 85014.345239 $37831.3800 $0.4500
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Subtotal (Total Children Is Unduplicated) 1479 7121 120014.241529 $1273706.6600 $10.6100
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Total 8203 120604.646261 $1304171.3600 $10.8100
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Number of Children (Unduplicated) With at Least One Authorization 1495