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 2041 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 -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 1.016666 $21.9100 $21.5500
EXIT -EXIT EXIT ASSESSMENT 3 3 2.766667 $138.3400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.383333 $28.7500 $74.9900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 13 5.811112 $435.8400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 28 30 9.044445 $678.3400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.411112 $30.8400 $75.0200
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 15 15 3.750000 $281.2500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 33 35 14.422221 $800.4300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.027778 $2.0900 $75.0600
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Subtotal (Total Children Is Unduplicated) 59 110 42.205556 $2639.5200 $62.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 2.933333 $14666.5000 $4999.9400
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 0.655555 $150.7700 $229.9800
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 238 352 453.761317 $22688.0500 $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 5 5 4.607937 $337.8600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 2.611111 $65.2800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 48 55 245.909524 $12295.4700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 829 1417 6667.028356 $66670.2600 $10.0000
PHY -97110 PT SESSION BY LICENSED PT 1 1 0.355556 $25.4000 $71.4500
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.511111 $33.2200 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 3.000000 $214.3200 $71.4400
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Subtotal (Total Children Is Unduplicated) 831 1927 7479.151577 $121432.3600 $16.2400
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Total 2041 7535.682530 $124071.8800 $16.4600
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Number of Children (Unduplicated) With at Least One Authorization 834