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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2675 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 34 38 38.787300 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 34 38 38.787300 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 14 5.433333 $263.5200 $48.5000
OCTH -97167 OT EVAL HIGH COMPLEXITY 28 32 10.222221 $521.8400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 16 17 17.987301 $918.2500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.022222 $52.1800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 24 27 14.505556 $740.5100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.116667 $5.7100 $48.9500
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Subtotal (Total Children Is Unduplicated) 69 93 49.287300 $2502.0100 $50.7600
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.022222 $51.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 63 209 55.549988 $2777.4400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 14 13.466668 $673.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2 3 6.671429 $333.5700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 15 14.205556 $710.2800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 0.355556 $17.7800 $50.0100
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 7 64.285713 $1607.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 230 290 2688.714275 $134435.8800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1384 1928 17853.421403 $178534.3600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 19 194.285712 $13879.8100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 5 6 32.285714 $1846.7500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 13 14 113.142857 $8082.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 13.428572 $767.5700 $57.1600
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 -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 3 3 3.044444 $54.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 12 106.142857 $7582.8600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 14 15 100.714288 $1397.9100 $13.8800
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Subtotal (Total Children Is Unduplicated) 1463 2544 21265.737254 $353945.5300 $16.6400
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Total 2675 21353.811854 $356447.5400 $16.6900
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Number of Children (Unduplicated) With at Least One Authorization 1496