Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-18 and 12-31-18 Date of Report: 02-05-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 6272 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 5 6 5.710502 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 6 5.710502 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 68 90 46.623115 $2261.2400 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.022222 $20.1500 $19.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.022222 $14.1800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.294444 $6.9800 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.022222 $9.2800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.022222 $28.4500 $27.8300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 13.142857 $640.8500 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 1 2 0.511111 $25.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 116 117 121.487521 $6074.3800 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 20.021916 $1501.6500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 13 13 24.005479 $1800.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 37 37 55.549311 $3083.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 31 57.510958 $4313.3300 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 2 0.252055 $12.8700 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 11.260938 $574.8700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 7 8 4.044444 $206.4700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.0900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 13.341684 $681.0900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 8 11 5.916667 $302.0500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 3.315145 $169.2300 $51.0500
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Subtotal (Total Children Is Unduplicated) 249 351 386.877644 $22016.2900 $56.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 21 22.742292 $113712.0000 $5000.0200
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.049315 $3.5300 $71.5900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 82 88 93.252478 $4662.6300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 1.538851 $38.4700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 613 822 1806.642275 $90332.4400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 13 13 24.669048 $616.7300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 278 339 677.065109 $33853.4200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 8.650000 $216.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 69 128.655563 $6432.8200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.166667 $4.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 490 593 1286.542907 $64327.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 9.550001 $238.7500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 39.857143 $2922.3300 $73.3200
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 129 158 1212.309533 $60615.5200 $50.0000
INTR -T1013 INTERPRETER 25 36 123.255186 $6162.7700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 734 1431 8270.508390 $82705.1700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 22 28 180.892860 $12922.9700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 24 30 220.516669 $15753.7100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 9.571429 $547.1000 $57.1600
SENS -V5264 EARMOLD 1 1 0.002740 $0.0500 $17.7400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 22 187.142858 $13369.5000 $71.4400
TRAV -TRAVS Travel by mile 825 2244 622432.980111 $276982.6800 $0.4500
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Subtotal (Total Children Is Unduplicated) 837 5915 636736.561425 $786420.3700 $1.2400
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Total 6272 637129.149571 $808436.6500 $1.2700
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Number of Children (Unduplicated) With at Least One Authorization 851