Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5194 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 2 2 1.866667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.866667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 63 87 37.375446 $1812.7300 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.465753 $8.3500 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $21.3500 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 1.465753 $18.4800 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.219178 $4.7200 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.465753 $12.1100 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 1.465753 $37.1000 $25.3100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.465753 $8.6400 $18.5500
EXIT -EXIT EXIT ASSESSMENT 119 120 147.002285 $7350.1000 $50.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 8.002740 $444.1500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 9 16.005479 $1200.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 17 17 28.016437 $1554.9200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 19 20 42.928571 $3219.6500 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 4 0.852131 $43.5000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 5 1.064384 $54.3400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 7 1.982497 $101.2100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 5 7 1.097260 $56.0200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 5 0.487672 $24.8900 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 6 1.765754 $90.1400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.573973 $29.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 15 18 4.245131 $216.7200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 0.216439 $11.0500 $51.0400
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.246575 $12.3300 $50.0100
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Subtotal (Total Children Is Unduplicated) 229 336 310.410717 $17232.1900 $55.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 16 5.853272 $29265.5000 $4999.8500
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.493151 $113.4400 $230.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 75 83 66.018398 $3300.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.255556 $31.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 495 705 1424.327345 $71216.3800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 8.433333 $210.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 194 242 459.550000 $22977.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 8.550000 $213.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 66 85 149.800001 $7490.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 376 467 845.322226 $42266.1300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 7.716666 $192.9200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 4.000000 $293.2800 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 102 127 886.222226 $44311.0600 $50.0000
INTR -T1013 INTERPRETER 30 49 120.166731 $6008.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 587 1147 5747.962729 $57479.5700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 23 26 255.857145 $18278.4200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 22 26 177.749999 $12698.4600 $71.4400
SENS -V5264 EARMOLD 1 1 0.711111 $12.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 33 39 286.571429 $20472.6400 $71.4400
TRAV -TRAVS Travel by mile 679 1824 440723.362443 $196121.9000 $0.4500
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Subtotal (Total Children Is Unduplicated) 695 4856 451179.923761 $532955.1800 $1.1800
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Total 5194 451492.201145 $550187.3700 $1.2200
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Number of Children (Unduplicated) With at Least One Authorization 708