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 1996 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 10 10 9.722223 $359.7300 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 14 15 29.779366 $359.7300 $12.0800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 6 7 7.000000 $339.5000 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 6 2.716666 $64.3800 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 2.000000 $169.6800 $84.8400
EXIT -EXIT EXIT ASSESSMENT 1 1 0.288889 $14.4500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 8 8 7.766667 $582.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 17 17 14.216667 $1066.2500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 8 3.916667 $293.7500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 13 13 8.833333 $490.2500 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 3.500000 $194.2500 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.000000 $100.0000 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 42 66 52.238889 $3315.0100 $63.4600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.922222 $46.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 2.800000 $140.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 7 8 6.355556 $1461.7900 $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 61 66 73.053176 $3652.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.311111 $32.7800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 4.522222 $331.5700 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 6.000000 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 9 10 26.563494 $664.0900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 73 80 508.116669 $25405.7900 $50.0000
INTR -T1013 INTERPRETER 1 1 3.200000 $160.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 853 1444 6886.119068 $68861.1100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 6 26.699999 $1907.4600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 12.857143 $735.4300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2 2 10.761904 $768.8300 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.500000 $32.5000 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 13 96.138098 $6868.1000 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 854 1915 8015.619870 $133449.0000 $16.6500
-------------------------------------------------------------------------------------------------------------------------------------
Total 1996 8097.638125 $137123.7400 $16.9300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 857