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 6021 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
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Subtotal (Total Children Is Unduplicated) 4 4 4.243651 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92585 AUD EVOKED RESPONSE (COMP) 7 8 5.333333 $347.4100 $65.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 1.022222 $47.8400 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 1.038889 $124.2500 $119.6000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 3.000000 $166.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.000000 $225.0000 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 29 35 23.296823 $1189.2900 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 93 108 50.743649 $2590.4500 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 35 42 24.378568 $1244.5100 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 60 64 33.167459 $1693.2000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.322222 $16.4500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 195 228 104.027774 $5310.6000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 3 3 1.844444 $94.1600 $51.0500
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Subtotal (Total Children Is Unduplicated) 309 498 251.175383 $13049.6600 $51.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.288889 $1444.5000 $5000.1900
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.633333 $151.4900 $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 3 3 35.142857 $878.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 387 470 3879.397623 $193970.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1236 3139 14837.939597 $148379.4000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 55 70 658.591274 $47049.7800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 29.814285 $1705.3800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 50 61 463.895243 $33140.6700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 16 19 116.007939 $6631.0100 $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 101 122 1111.972224 $79439.3200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 34.285715 $475.8900 $13.8800
TRAV -TRAVS Travel by mile 64 86 85014.345239 $37831.3800 $0.4500
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Subtotal (Total Children Is Unduplicated) 1320 5519 107300.983973 $608461.9900 $5.6700
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Total 6021 107556.403007 $621511.6500 $5.7800
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Number of Children (Unduplicated) With at Least One Authorization 1359