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: 01-01-19 and 03-31-19 Date of Report: 05-04-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3292 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 2 2 1.200000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 18.857143 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 46 46 48.947621 $1811.0700 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 50 51 69.004764 $1811.0700 $26.2500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 9 8.666667 $420.3400 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 22 26 8.533335 $118.3600 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 48 50 25.833333 $612.2500 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 2.000000 $169.6800 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.511111 $8.5400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 11.857143 $265.6000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 2.588889 $116.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 2.188889 $251.7200 $115.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 0.288889 $14.4500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 16 12.833333 $962.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 21 34 28.994444 $2174.5800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 12 20 14.927779 $1119.5900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 14 25 24.533333 $1361.6000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 6.500000 $487.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 12 12 18.500000 $1026.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 1.500000 $112.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.000000 $100.0000 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 119 214 174.257145 $9472.4500 $54.3600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 12 11.266667 $56333.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.922222 $46.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 4.800000 $240.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.133333 $81.1600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 37 38 31.522223 $7250.1300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 29 29 29.166666 $1458.3300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 85 103 138.451589 $6922.5900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 54 63 67.914286 $3395.7200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.911111 $22.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 64 74 111.000000 $5550.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.255556 $6.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 62 67 73.553176 $3677.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.311111 $32.7800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 15 16 24.803968 $1818.6300 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 6.000000 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 18 23 70.315877 $1757.9000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 749 918 5302.463501 $265122.8200 $50.0000
INTR -T1013 INTERPRETER 1 1 3.200000 $160.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 853 1445 6891.985735 $68919.7800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 66 79 459.303967 $32812.6700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 7 7 33.661904 $1925.4500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 50 55 392.547624 $28043.5900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 25.980953 $1485.0700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.500000 $32.5000 $65.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 2.955556 $1347.7500 $456.0100
SENS -V5264 EARMOLD 4 5 4.833334 $87.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 65 68 425.503975 $30397.9800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 4.504762 $62.5300 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 860 3027 14121.769096 $519015.8000 $36.7500
-------------------------------------------------------------------------------------------------------------------------------------
Total 3292 14365.031005 $530299.3200 $36.9200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 863