Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3214 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 43 48 31.461106 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 43 48 31.461106 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 58 105 60.283945 $2923.7800 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.035616 $4.0900 $114.9500
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 19 25 14.061112 $717.8200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 22 25 16.268569 $830.5100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 40 51 33.809361 $1725.9700 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 126 209 126.458603 $6304.2800 $49.8500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 17 13.955555 $69777.5000 $4999.9800
CONIF -CONIF CONSULT, ITDS FACE TO FACE 561 781 1893.279375 $94663.9900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 319 425 991.276988 $49563.8700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 257 367 801.662702 $40083.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 632 859 1725.415115 $86270.9000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 236 312 1934.647620 $96732.4400 $50.0000
INTR -T1013 INTERPRETER 34 47 342.313495 $17115.6800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 23 31 276.552380 $19756.9000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 31 40 306.526984 $21898.3100 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.035616 $8.1200 $227.9000
SENS -V5264 EARMOLD 1 1 0.035616 $0.6400 $17.9900
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 58 76 622.671429 $44483.6700 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 839 2957 8908.372875 $540355.1200 $60.6600
-------------------------------------------------------------------------------------------------------------------------------------
Total 3214 9066.292584 $546659.4000 $60.3000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 887