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: 04-01-19 and 06-30-19 Date of Report: 07-21-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3270 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 5 5 4.419047 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 4 10.680953 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 54 54 143.216661 $5299.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 63 63 158.316661 $5299.0000 $33.4700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 6.961111 $337.6100 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 21 21 8.183338 $113.5100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 54 58 23.388891 $554.3200 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.255556 $21.6900 $84.8500
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.388889 $19.8600 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 13.000000 $291.2000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 1.505555 $67.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 1.505555 $173.1300 $115.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 11 12.383333 $928.7500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 12 16 15.927777 $1194.5800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 12 5.650001 $423.7600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 8 3.866667 $214.6000 $55.5000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.516667 $75.8400 $50.0000
SCREEN-T1023 SCREENING 4 5 17.066666 $853.3300 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 109 156 123.600006 $5964.9700 $48.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 16 13.805556 $69028.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 1.166667 $58.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 14.000000 $700.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 33 34 21.755558 $5003.8300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 28 34 25.082540 $1254.1300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 54 72 84.092066 $4204.6200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 49 54 78.277780 $3913.9000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 64 73 119.938889 $5996.9500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.277778 $6.9500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 52 62 62.398413 $3119.9300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.944445 $98.6100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 15 18 30.777778 $2256.6300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 20 22 79.041272 $1976.0300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 698 891 5146.145256 $257307.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 881 1460 7127.487324 $71274.8900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 76 83 466.883331 $33354.1400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 14.561904 $832.9400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 76 91 557.280956 $39812.1500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 4 24.923810 $1424.6400 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.505555 $32.8600 $64.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 3.011111 $1373.0600 $456.0000
SENS -V5264 EARMOLD 3 4 4.022222 $72.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 92 110 589.285714 $42098.5500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 13.142858 $182.4200 $13.8800
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Subtotal (Total Children Is Unduplicated) 894 3051 14481.808783 $545383.2800 $37.6600
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Total 3270 14763.725450 $556647.2500 $37.7000
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Number of Children (Unduplicated) With at Least One Authorization 900