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: 07-01-18 and 06-30-19 Date of Report: 07-21-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4787 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 9 9 6.730158 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 11 77.223810 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 12 12 38.622224 $1429.0300 $37.0000
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Subtotal (Total Children Is Unduplicated) 28 32 122.576192 $1429.0300 $11.6600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 16 17 15.983334 $775.1900 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 14 14 11.483334 $272.1600 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 3.466667 $294.1100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 0.716667 $36.6000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $16.7000 $16.7000
EXIT -EXIT EXIT ASSESSMENT 6 6 46.866667 $2343.3400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 24 25 22.405555 $1680.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 39 39 35.819046 $2686.4200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 17 17 13.366665 $1002.4900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 30 30 28.666666 $1591.0000 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 213.500000 $11849.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 2.650000 $198.7500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 3.550000 $177.5000 $50.0000
SCREEN-T1023 SCREENING 2 2 11.947619 $597.3800 $50.0000
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Subtotal (Total Children Is Unduplicated) 106 163 411.422220 $23521.3000 $57.1700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 6.055556 $30278.0000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.933333 $96.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 3 19.185714 $959.2900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 14 17 16.016666 $3683.8200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 87 106 122.515079 $6125.7500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.500000 $37.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 267 392 818.149204 $40907.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 3.233333 $80.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 106 126 231.021430 $11551.0800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.333333 $33.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 108 141 354.482540 $17724.1400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.533333 $13.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 99 121 213.864285 $10693.2100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 6.422222 $160.5600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 12 22.777777 $1670.0600 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 25.714286 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 17 19 85.580949 $2139.5300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 142 188 2198.050000 $109902.5300 $50.0000
INTR -T1013 INTERPRETER 3 5 34.666667 $1733.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1433 3404 28808.058711 $288080.5600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 55.569841 $3969.9200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 19.857143 $1135.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 5 6 39.328572 $2809.6400 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 3 2.027777 $131.8000 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 16 205.776191 $14700.6600 $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) 1436 4592 33298.225371 $548682.2400 $16.4800
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Total 4787 33832.223783 $573632.5600 $16.9600
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Number of Children (Unduplicated) With at Least One Authorization 1446