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 1941 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 12 12 28.899999 $1069.3000 $37.0000
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Subtotal (Total Children Is Unduplicated) 21 21 43.999999 $1069.3000 $24.3000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 7 6.227778 $302.0500 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 9 6.305557 $149.4500 $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
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 5 5.250000 $393.7500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 7 7 6.072222 $455.4200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 1.088890 $81.6800 $75.0100
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 0.866667 $48.1000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.516667 $75.8400 $50.0000
SCREEN-T1023 SCREENING 2 2 9.233333 $461.6700 $50.0000
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Subtotal (Total Children Is Unduplicated) 31 42 38.205559 $2059.4800 $53.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.011111 $50.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 3.761112 $865.0800 $230.0100
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 51 60 61.626191 $3081.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.944445 $98.6100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 4 5.100000 $373.9300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 8 29.714287 $742.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 61 72 451.070633 $22553.5300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 880 1458 7115.687324 $71156.8900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 25.414285 $1815.6000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.428571 $310.5200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 4 5 27.566667 $1969.3700 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 2 0.505555 $32.8600 $64.9900
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 15 116.495238 $8322.4200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 4.571429 $63.4500 $13.8800
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Subtotal (Total Children Is Unduplicated) 883 1878 8160.565901 $131813.5000 $16.1500
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Total 1941 8242.771459 $134942.2800 $16.3700
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Number of Children (Unduplicated) With at Least One Authorization 889