Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5429 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 11 9.922222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 11 9.922222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 63 88 16.381121 $794.4900 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 25.428571 $2924.2900 $115.0000
EXIT -EXIT EXIT ASSESSMENT 116 117 73.515071 $3675.7400 $50.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 27 27 12.110952 $908.3500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 6.021916 $451.6500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 24 24 16.083557 $892.6500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 14 14 2.069858 $155.2600 $75.0100
NURS -T1001 NURSING ASSESSMENT 1 1 0.002740 $0.1400 $49.2700
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 2 2 0.405479 $20.7000 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.043836 $2.2400 $51.0100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 8 8 3.094520 $157.9700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 6 1.210655 $61.8000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 0.698249 $35.6500 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.317808 $16.2200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.166667 $8.5100 $51.0600
PSTH -97001 EVAL BY LICENSED PT, INITIAL 7 8 1.249999 $63.8200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 3 0.661644 $33.7700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 0.846575 $43.2200 $51.0500
SCREEN-T1023 SCREENING 6 7 1.679375 $83.9700 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 19 20 5.469633 $279.2300 $51.0500
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Subtotal (Total Children Is Unduplicated) 245 345 167.463705 $10610.0800 $63.3600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 39 8.026176 $40129.5000 $4999.8300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 108 134 39.843072 $1992.1000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 8 8.716666 $217.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 449 668 1214.264426 $60713.2200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 14 14 27.469047 $686.7300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 139 198 355.711905 $17785.6000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 8 12.947619 $323.6900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 95 127 225.620010 $11280.9800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 5 5 11.394444 $284.8600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 344 445 800.955555 $40047.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 6 9.633334 $240.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 107 132 868.889428 $43444.4400 $50.0000
INTR -T1013 INTERPRETER 23 31 154.261693 $7713.0700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 608 1206 5961.252460 $59612.4500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 46 65 567.714291 $40557.4600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 52 66 536.452056 $38324.0900 $71.4400
SENS -V5264 EARMOLD 1 1 0.317808 $5.7200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 91 121 1096.623877 $78342.7400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 8.714286 $120.9500 $13.8800
TRAV -TRAVS Travel by mile 700 1798 373073.857108 $166017.8800 $0.4500
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Subtotal (Total Children Is Unduplicated) 725 5073 384982.665261 $607841.9800 $1.5800
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Total 5429 385160.051188 $618452.0700 $1.6100
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Number of Children (Unduplicated) With at Least One Authorization 737