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 2975 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 0.211111 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1 1 0.211111 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.222222 $10.7800 $48.5000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.122222 $10.3700 $84.8200
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.060274 $2.7100 $45.0200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.060274 $6.9300 $115.0500
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.285714 $15.8600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.285714 $21.4300 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 9 10 2.994444 $152.8600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 40 43 23.676983 $1208.7000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 10 11 4.749999 $242.4800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 35 41 27.117457 $1384.3300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 66 76 28.305556 $1445.0000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.511111 $26.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.688889 $33.7100 $48.9400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 119 191 90.080859 $4611.2700 $51.1900
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 3 3 31.999999 $800.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 143 171 1262.771433 $63138.6100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1156 1535 10859.590468 $108596.0200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 24 27 208.747621 $14912.9300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 10.000000 $572.0000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 33 40 308.785714 $22059.6700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 35.000001 $2000.5900 $57.1600
SENS -V5130 IN EAR BINAURAL HEARING AID
1 1 0.060274 $27.5000 $456.2000
SENS -V5264 EARMOLD 1 1 0.244444 $4.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 31 37 264.928573 $18926.5000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.857143 $506.6300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 19.714286 $273.6300 $13.8800
TRAV -TRAVS Travel by mile 31 44 36736.904763 $16347.9200 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1188 2783 50383.388009 $280694.1300 $5.5700
-------------------------------------------------------------------------------------------------------------------------------------
Total 2975 50473.679979 $285305.3900 $5.6500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1216