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: 07-01-18 and 09-30-18 Date of Report: 11-06-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2152 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 1.111111 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 6 13.733333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 8 14.844444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 4.388889 $212.8600 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 2.022222 $47.9300 $23.7000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.327778 $16.7400 $51.0700
EXIT -EXIT EXIT ASSESSMENT 2 2 41.000000 $2050.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 18 18 8.605556 $645.4200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 27 27 11.796825 $884.7600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.094444 $7.0800 $74.9700
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 14 14 10.088888 $756.6600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 23 23 18.155554 $1007.6200 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 184.000000 $10212.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 2.650000 $198.7500 $75.0000
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Subtotal (Total Children Is Unduplicated) 58 98 283.130156 $16039.8200 $56.6500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.000000 $20000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 3 13.319047 $665.9500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.066667 $76.3900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 9 11 8.299999 $1908.9800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 27 30 53.088096 $2654.4100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 205 290 358.894436 $17944.6800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 2.627777 $65.6900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 50 51 36.141267 $1807.0500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 31 35 39.757141 $1987.8600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 34 36 25.707935 $1285.3900 $50.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 5 8.366667 $613.4500 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 6.571429 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 10.112698 $252.8200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 80 94 679.877777 $33993.9000 $50.0000
INTR -T1013 INTERPRETER 3 5 17.966666 $898.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 848 1469 7058.839635 $70588.3900 $10.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.511111 $33.2200 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $938.9300 $71.4400
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Subtotal (Total Children Is Unduplicated) 850 2046 8338.291205 $155715.4200 $18.6700
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Total 2152 8636.265805 $171755.2400 $19.8900
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Number of Children (Unduplicated) With at Least One Authorization 855