Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 3192 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 3 3 1.366666 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 16.285714 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 17.652380 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 5 1.533333 $74.3700 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 1.761111 $22.2100 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 58 63 58.376190 $1258.0100 $21.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 8 5.233334 $235.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 9 3.188889 $366.7200 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.005556 $0.2800 $50.4000
EXIT -EXIT EXIT ASSESSMENT 7 7 4.505555 $225.2800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 21 30 19.872223 $1490.4200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 31 53 66.492857 $4986.9700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.816667 $61.2500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 18 26 20.694445 $1552.0900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 33 52 47.222220 $2620.8200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 2 1.500000 $112.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 12 12 24.000000 $1332.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 22.000000 $1650.0000 $75.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.822222 $41.9700 $51.0500
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Subtotal (Total Children Is Unduplicated) 134 286 278.024602 $16030.3900 $57.6600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 11 8.533334 $42667.0000 $5000.0400
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 5 3.512698 $175.6300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.388889 $27.8500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 36 39 18.827777 $4330.3700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 29 29 19.465079 $973.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.150000 $28.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 210 319 467.417456 $23370.8500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 6 3.088888 $77.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 6 3.027778 $151.3900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 6 7.044445 $352.2300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.333333 $8.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 3.472222 $173.6100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.133333 $3.3300 $24.9900
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 11 11 14.250001 $1044.8200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 8 53.392064 $1334.8000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 757 1025 6150.425433 $307520.9800 $50.0000
INTR -T1013 INTERPRETER 1 1 8.266667 $413.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 776 1372 6571.134153 $65711.2700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 16 22 121.999998 $8715.6700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.133333 $64.8200 $57.2000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.500000 $32.5000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 0.500000 $114.0000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.033333 $7.5900 $227.7700
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
4 7 5.444444 $2482.6500 $456.0000
SENS -V5264 EARMOLD 5 8 3.100000 $55.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 7 35.671427 $2548.3600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.928571 $53.1200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 7.638096 $106.0200 $13.8800
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Subtotal (Total Children Is Unduplicated) 782 2901 13510.812752 $462545.5300 $34.2400
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Total 3192 13806.489734 $478575.9200 $34.6600
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Number of Children (Unduplicated) With at Least One Authorization 789