Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 6041 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 19 25 9.466664 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 25 9.466664 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 19 6.126864 $297.1400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 7.214286 $370.4500 $51.3500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 2.214285 $99.6400 $45.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 0.294445 $15.0300 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 280 355 125.257148 $6394.4000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 1.061111 $54.1700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 245 305 151.351583 $7726.4700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 169 208 63.344447 $3233.7500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 1 1 0.500000 $25.5300 $51.0500
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Subtotal (Total Children Is Unduplicated) 539 898 357.364169 $18216.5900 $50.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.200000 $1000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 1.022222 $51.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 3.655556 $182.7800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 56 147 46.022228 $2301.1400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 30 36 22.944446 $1147.2300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 18 24 11.627779 $581.4000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 12 13.955556 $697.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 13 18 12.350000 $617.5000 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 174 234 1805.428574 $45135.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1324 1725 15806.061974 $790302.3500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1291 1791 16277.957218 $162779.4100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 331 444 2977.214279 $212691.9800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 0.428571 $24.5200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 287 372 2787.620634 $199147.3300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 2.857143 $163.3100 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 3 1.344444 $306.5200 $227.9900
SENS -V5060 BEHIND EAR HEARING AID
1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 1 0.655556 $298.9500 $456.0300
SENS -V5264 EARMOLD 3 5 2.411111 $43.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 228 294 1796.142854 $128316.3600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.000000 $57.2000 $57.2000
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Subtotal (Total Children Is Unduplicated) 1645 5118 41571.900145 $1546073.9400 $37.1900
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Total 6041 41938.730978 $1564290.5300 $37.3000
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Number of Children (Unduplicated) With at Least One Authorization 1657