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 2201 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
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Subtotal (Total Children Is Unduplicated) 6 7 22.809523 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 6 5.366667 $260.2900 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 1.438889 $34.1000 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 2.211111 $187.5900 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $16.7000 $16.7000
EXIT -EXIT EXIT ASSESSMENT 3 3 4.577778 $228.8900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 13 7.355555 $551.6600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 23 23 10.727777 $804.5800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 14 14 7.127778 $534.5900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 20 20 11.638889 $645.9600 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 26.000000 $1443.0000 $55.5000
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Subtotal (Total Children Is Unduplicated) 54 88 77.444444 $4707.3500 $60.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 3.055556 $15278.0000 $5000.0700
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 3.066667 $153.3400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 5.533333 $1272.6600 $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 55 59 58.249206 $2912.4600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.166667 $29.1700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 5.900000 $432.5900 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 13.142857 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 6 14.619048 $365.4800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 87 102 643.332537 $32166.6700 $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 1 1 0.455556 $32.5500 $71.4500
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.571429 $89.8800 $57.2000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.511111 $33.2200 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 0.142857 $10.2100 $71.4600
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Subtotal (Total Children Is Unduplicated) 898 2106 8571.498388 $150409.5200 $17.5500
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Total 2201 8671.752355 $155116.8700 $17.8900
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Number of Children (Unduplicated) With at Least One Authorization 900