Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 5942 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 104 111 204.823017 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 104 111 204.823017 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.666667 $30.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 5.118722 $588.6600 $115.0000
EXIT -EXIT EXIT ASSESSMENT 66 66 128.057534 $6402.8800 $50.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 73 74 135.842923 $7121.0900 $52.4200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 3.000000 $15000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 13 20.611113 $1030.5700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 37 46 67.644449 $3382.2500 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 9.066667 $2085.3400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 197 212 47.622525 $2381.3700 $50.0100
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 2.355954 $58.9000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 46 54 70.188890 $3509.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 20 25 41.371428 $1034.2800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 18 24.566666 $1228.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 11 14 12.259523 $306.4900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 17 19 30.416666 $1520.8300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 3.583333 $89.5800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 38 48 65.251588 $3262.5800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 14 17 29.214286 $730.3600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 93 122 3404.285717 $85107.1200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1245 1600 12601.947606 $630098.2000 $50.0000
INTR -T1013 INTERPRETER 30 33 251.361903 $12568.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1620 2407 18838.080949 $188381.0300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 191 254 1166.455956 $83331.6300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 41 51 251.060718 $14360.6800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 174 235 1102.311921 $78749.0900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 4.450000 $254.3600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 4.935161 $320.7900 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 4 5 4.333334 $988.0200 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 8 8 17.266667 $7873.6200 $456.0000
SENS -V5264 EARMOLD 40 49 64.877779 $1167.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 387 489 2580.735746 $184367.5900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 38.285715 $531.4000 $13.8800
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Subtotal (Total Children Is Unduplicated) 1773 5757 40759.542260 $1324175.7300 $32.4900
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Total 5942 41100.208200 $1331296.8200 $32.3900
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Number of Children (Unduplicated) With at Least One Authorization 1859