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 2573 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 19 25 9.466664 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 16 4.921309 $238.6800 $48.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.116667 $5.9600 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 32 38 10.261113 $523.8400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.500000 $25.5300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 22 23 49.823016 $2543.4600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 19 22 5.866668 $299.5000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 75 101 71.488773 $3636.9600 $50.8700
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.677778 $33.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $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 8 11 11.555556 $577.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 9 12 4.477778 $223.8900 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 8.285714 $207.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 260 331 2784.928591 $139246.3100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1291 1791 16277.957218 $162779.4100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 35 41 285.928572 $20426.7000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 20 22 219.214286 $15660.6300 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
1 1 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 2 2 1.411111 $25.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 25 175.214288 $12517.2800 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1374 2447 19853.245345 $356234.1900 $17.9400
-------------------------------------------------------------------------------------------------------------------------------------
Total 2573 19934.200782 $359871.1500 $18.0500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1391