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: 04-01-17 and 06-30-17 Date of Report: 08-05-17 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2426 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 6 6 1.933332 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 9 26.180952 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 15 28.114284 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 2.505556 $121.5200 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 1.511112 $32.5700 $21.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.127778 $2.6400 $20.6800
EXIT -EXIT EXIT ASSESSMENT 9 10 11.027778 $551.3900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.127778 $9.5900 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 20 20 9.322227 $699.2000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 65 69 29.727792 $2229.6900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 1.477777 $110.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 37 38 19.721434 $1479.1400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 73 75 34.671443 $1924.3400 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 3.000000 $166.5000 $55.5000
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Subtotal (Total Children Is Unduplicated) 116 226 113.220675 $7327.4100 $64.7200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 0.877778 $4389.0000 $5000.1300
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 3.277778 $163.8900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 5 6 2.516668 $578.8600 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 63 76 169.984128 $8499.2200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 301 468 525.871351 $26293.6800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 15 15 13.003967 $325.1000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 4 2.727778 $136.3900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 1.433334 $71.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.033333 $75.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 4.100000 $205.0000 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 13.993651 $1026.0300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 9 43.376192 $1084.4100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 50 54 359.001590 $17950.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 842 1531 7290.922178 $72909.2600 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.122222 $7.9400 $64.9900
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 0.066667 $4.7700 $71.4700
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Subtotal (Total Children Is Unduplicated) 843 2185 8435.308615 $133746.1200 $15.8600
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Total 2426 8576.643574 $141073.5300 $16.4500
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Number of Children (Unduplicated) With at Least One Authorization 854