Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 4990 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 12 12 8.983333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.977778 $36.1800 $37.0000
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Subtotal (Total Children Is Unduplicated) 13 13 9.961111 $36.1800 $3.6300
Screening, Eval, and Assessment, Class # 02
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 2.383333 $183.8200 $77.1300
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 1.000000 $75.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 29 36 16.734125 $854.2700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 87 98 37.734917 $1926.3600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 44 57 30.015075 $1532.2500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 0.511111 $26.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 58 64 37.446826 $1911.6700 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.300000 $15.3200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 149 168 136.296819 $6957.9200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 49 51 32.755555 $1672.1700 $51.0500
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Subtotal (Total Children Is Unduplicated) 291 483 296.177761 $15210.3700 $51.3600
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.833333 $41.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 241 286 216.450774 $10822.4500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.522222 $13.0600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 53 48.828570 $2441.4300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 767 912 682.468198 $34123.1300 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 7 35.857141 $896.4400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 181 218 1730.298419 $86515.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1225 2672 13497.261894 $134972.6400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 49 64 438.119052 $31299.2100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.857143 $106.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 59 75 547.041276 $39080.6200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 11 13 114.285713 $6532.5800 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 82 96 807.170634 $57664.3100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 2 21.857142 $1250.2300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 3.066667 $42.5700 $13.8800
TRAV -TRAVS Travel by mile 51 91 73408.185727 $32666.6400 $0.4500
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Subtotal (Total Children Is Unduplicated) 1316 4494 91555.103905 $438698.2000 $4.7900
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Total 4990 91861.242777 $453944.7500 $4.9400
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Number of Children (Unduplicated) With at Least One Authorization 1364