Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 5229 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 3 3 0.893651 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 5 6 4.744444 $175.5400 $37.0000
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Subtotal (Total Children Is Unduplicated) 8 9 5.638095 $175.5400 $31.1400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.222222 $10.7800 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 0.411111 $34.8800 $84.8400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.638052 $28.7100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.638052 $73.3800 $115.0100
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 2 2.000000 $111.0000 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 10 10 17.285714 $959.3600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 17.285714 $1296.4300 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 18 19 6.955556 $355.0800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.227778 $11.6300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 118 133 68.757143 $3510.0600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 31 32 13.950000 $712.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 114 137 89.410313 $4564.3900 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.138889 $7.0900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.511111 $26.0900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 191 224 97.171430 $4960.6100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 5 6 1.661111 $84.8000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 9 9 4.451587 $217.8600 $48.9400
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Subtotal (Total Children Is Unduplicated) 341 594 323.715783 $17042.1200 $52.6500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.222222 $1111.0000 $4999.5000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 13.720634 $686.0300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 211 242 169.288080 $8464.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 36 42 26.807935 $1340.3900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 531 617 411.299181 $20564.8500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 14.445238 $361.1300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 137 157 1303.142854 $32578.6300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1132 1336 10514.292859 $525715.2600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1157 1536 10865.590468 $108656.0200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 147 170 921.390495 $65824.0200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 23 25 133.928576 $7660.6900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 129 158 1066.211915 $76170.1600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 20 21 132.153972 $7553.9000 $57.1600
SENS -V5130 IN EAR BINAURAL HEARING AID
1 1 0.060274 $27.5000 $456.2000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.284932 $129.9100 $455.9500
SENS -V5264 EARMOLD 2 2 1.400000 $25.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 202 228 1363.857160 $97433.8600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 8 32.714287 $1871.2500 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 26 26 141.142859 $1959.0600 $13.8800
TRAV -TRAVS Travel by mile 31 44 36736.904763 $16347.9200 $0.4500
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Subtotal (Total Children Is Unduplicated) 1357 4626 63848.858704 $974481.1100 $15.2600
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Total 5229 64178.212582 $991698.7700 $15.4500
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Number of Children (Unduplicated) With at Least One Authorization 1364