Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 3110 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 55 61 48.888890 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 55 61 48.888890 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.252055 $11.3400 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.252055 $28.9900 $115.0200
EVAL -96111 DEVELOPMENTAL EVALUATION 16 20 3.498856 $174.9600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 19 19 16.273974 $813.7000 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 17 17 30.010958 $2250.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 10 10 16.010958 $1200.8300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 18 18 32.010958 $2400.8300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 6 6 6.016437 $333.9200 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 21 26 6.272221 $320.1900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.087671 $4.4800 $51.0700
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 10 12 3.755556 $191.7200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 12 12 2.766665 $141.2300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 3 0.744444 $38.0000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 6 3.145238 $160.5700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.844444 $43.1100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 34 43 22.638289 $1155.6700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 7 8 2.961111 $151.1600 $51.0500
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Subtotal (Total Children Is Unduplicated) 140 206 147.714112 $9430.3000 $63.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 7 125.791781 $628959.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 2 1.022222 $51.1100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 2 1.022222 $235.1100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 20 26 10.733943 $536.7000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 10 8.955554 $223.8900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 295 405 329.553165 $16477.6200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 269 343 462.677787 $11566.9700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 220 488 309.427751 $15471.2600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 101 202 252.838892 $6320.9800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 98 218 128.835703 $6441.7300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 55 120 153.716667 $3842.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 237 290 243.689678 $12184.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 232 282 392.771435 $9819.3000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 6 38.000000 $950.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 104 134 908.859517 $45443.0300 $50.0000
INTR -T1013 INTERPRETER 1 2 1.022222 $51.1100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 64 80 560.352379 $40031.6000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 32 46 372.214287 $21290.6600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 26 34 235.602380 $16831.4400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 20 27 204.071429 $11664.7300 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 2 2.000000 $912.0000 $456.0000
SENS -V5264 EARMOLD 2 3 2.044444 $36.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 91 113 878.285714 $62744.7700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.428571 $33.7100 $13.8800
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Subtotal (Total Children Is Unduplicated) 631 2843 5625.917743 $912120.8800 $162.1300
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Total 3110 5822.520745 $921551.1800 $158.2700
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Number of Children (Unduplicated) With at Least One Authorization 709