Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 2553 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 19 20 11.361110 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 20 11.361110 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 19 15.698555 $761.3900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 2.571429 $132.0400 $51.3500
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.0900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 27 30 9.616664 $490.9200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.172222 $8.7900 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 22 29 18.911905 $965.4600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 18 22 5.811112 $296.6600 $51.0500
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Subtotal (Total Children Is Unduplicated) 69 103 53.292998 $2681.3500 $50.3100
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.200000 $10.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 48 136 34.266669 $1713.3500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 30 30 31.733331 $1586.6600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 22 25 18.866665 $943.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 8 7.288888 $364.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 14 14 11.316665 $565.8300 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 13.571428 $339.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 225 287 2828.845223 $141442.3900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1315 1838 17016.772156 $170167.8700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 30 33 249.274602 $17808.2200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 22 30 238.285713 $17023.1700 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 1 0.200000 $91.2000 $456.0000
SENS -V5264 EARMOLD 1 1 0.400000 $7.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 19 23 170.285712 $12165.2400 $71.4400
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Subtotal (Total Children Is Unduplicated) 1391 2430 20621.307052 $364228.1600 $17.6600
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Total 2553 20685.961160 $366909.5100 $17.7400
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Number of Children (Unduplicated) With at Least One Authorization 1413