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: 04-01-18 and 06-30-18 Date of Report: 08-10-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3561 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 0.600000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 6 11.800001 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6 8 12.400001 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 3 3.000000 $145.5000 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 12 12 4.544446 $57.3100 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 55 60 24.145246 $520.3500 $21.5500
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 9 4.627779 $208.2600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 9 4.144446 $476.6300 $115.0000
EXIT -EXIT EXIT ASSESSMENT 4 4 141.611111 $7080.5600 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 19 26 13.194446 $989.6000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 29 51 63.788891 $4784.1800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.022222 $1.6700 $74.9300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 21 31 10.638892 $797.9400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 23 44 27.122223 $1505.2900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 5 6.300000 $472.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 21 21 198.000000 $10989.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 23 23 45.033334 $3377.5100 $75.0000
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.294444 $15.0300 $51.0400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 138 300 546.467480 $31421.3000 $57.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 11 10.188889 $50944.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 16.555556 $827.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 29 32 13.550004 $3116.5900 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 28 28 19.488889 $974.4500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 229 350 414.050006 $20702.5300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 1.877778 $46.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 19 5.372223 $268.6200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 11 13 12.565079 $628.2600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 10 7.094445 $354.7300 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 16 18 29.305555 $2148.6800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 21 22 85.158728 $2128.9700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 834 1134 6442.250827 $322112.6800 $50.0000
INTR -T1013 INTERPRETER 3 3 18.199999 $910.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 859 1559 7119.480980 $71194.8300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 17 19 117.609522 $8402.0200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 18.085715 $1034.5000 $57.2000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.505556 $32.8600 $65.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.505556 $115.2800 $228.0200
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.011111 $230.5300 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 5 6.583333 $3001.9800 $456.0000
SENS -V5264 EARMOLD 6 7 6.100001 $109.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 5 26.780952 $1913.2300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 13.000000 $180.4400 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 862 3253 14386.320704 $491405.1800 $34.1600
-------------------------------------------------------------------------------------------------------------------------------------
Total 3561 14945.188185 $522826.4800 $34.9800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 864