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: 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 3416 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 1 1 0.511111 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 13.814286 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 14.325397 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 7 4.572222 $221.7500 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.166667 $3.5600 $21.3500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 72 74 81.476190 $1755.8100 $21.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 1.844444 $83.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 2.377777 $273.4400 $115.0000
EXIT -EXIT EXIT ASSESSMENT 3 3 2.766667 $138.3400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 1.150000 $86.2500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 22 35 25.411110 $1905.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 40 74 37.594441 $2819.5600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 3 1.022223 $76.6700 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 26 42 22.511111 $1688.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 48 84 61.505555 $3413.5500 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 26 26 92.000000 $5106.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 21 22 40.083334 $3006.2600 $75.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.188889 $9.6400 $51.0500
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Subtotal (Total Children Is Unduplicated) 168 383 374.670630 $20587.9800 $54.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 13 7.461111 $37305.5000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 7.653968 $382.7000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.227778 $16.3100 $71.6200
AUDE -V5160 DISPENSING FEE BINAURAL 46 49 20.511109 $4717.5100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 44 47 49.392856 $2469.6500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 8 8 5.505556 $137.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 238 354 455.205761 $22760.2700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 11 11 15.573810 $389.3500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 8 9.305555 $465.2800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 6 12.266667 $613.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.066667 $76.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 1.666666 $83.3300 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 13 14 21.074604 $1545.2000 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 17 18 88.977778 $2224.4500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 789 1020 5948.237282 $297411.8000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 829 1417 6667.028356 $66670.2600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 22 24 168.296825 $12023.1200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 21.819047 $1248.0500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 4 4 12.533334 $895.3900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 2.800000 $160.0500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.511111 $33.2200 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.511111 $116.5300 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
2 2 1.533333 $699.1800 $455.9900
SENS -V5264 EARMOLD 3 4 2.177778 $39.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 11 12 64.276191 $4591.9000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.571429 $375.8800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 14.199999 $197.0900 $13.8800
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Subtotal (Total Children Is Unduplicated) 839 3029 13608.385682 $457648.8300 $33.6300
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Total 3416 13997.381709 $478236.8100 $34.1700
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Number of Children (Unduplicated) With at Least One Authorization 840