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: 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 3538 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 1 1 1.000000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 6 21.809523 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 2.033333 $75.2300 $37.0000
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Subtotal (Total Children Is Unduplicated) 7 8 24.842856 $75.2300 $3.0300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 9 8.366667 $405.7900 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 20 22 8.416664 $116.7400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 52 54 26.033333 $616.9900 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 2.211111 $187.5900 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.855556 $30.9900 $16.7000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 6 3.511111 $158.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 3.533333 $406.3300 $115.0000
EXIT -EXIT EXIT ASSESSMENT 3 3 4.577778 $228.8900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 22 33 22.094442 $1657.0700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 37 58 38.738886 $2905.4000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 21 34 25.805556 $1935.4200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 25 44 38.355555 $2128.7300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 0.600000 $45.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 30.000000 $1665.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.600000 $45.0000 $75.0000
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Subtotal (Total Children Is Unduplicated) 136 279 214.699992 $12532.9200 $58.3700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 18 14.388890 $71945.0000 $5000.0400
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 5 6.555556 $327.7800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 1.477777 $105.8200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 39 40 32.594444 $7496.7100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 25 26 23.294444 $1164.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.500000 $12.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 174 236 293.105554 $14655.2700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 0.605556 $15.1400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 53 61 60.360317 $3018.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.422222 $10.5600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 46 50 94.811903 $4740.5900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 56 60 58.588095 $2929.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.166667 $29.1700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 18 20 44.485715 $3261.6900 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 13.142857 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 17 17 48.365081 $1209.1200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 869 1115 6717.108703 $335855.5400 $50.0000
INTR -T1013 INTERPRETER 2 2 13.500000 $675.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 894 1539 7334.151568 $73341.5300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 25 27 134.418259 $9602.8600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 9.000000 $514.8000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1 1 2.142857 $153.0900 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.511111 $33.2200 $65.0000
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 2 2 2.000000 $912.0000 $456.0000
SENS -V5264 EARMOLD 5 6 5.044444 $90.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 9 9 24.323809 $1737.6900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 0.428571 $5.9500 $13.8800
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Subtotal (Total Children Is Unduplicated) 900 3251 14938.494400 $534299.9500 $35.7700
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Total 3538 15178.037248 $546908.1000 $36.0300
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Number of Children (Unduplicated) With at Least One Authorization 903