Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 6049 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 115 123 175.983335 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 115 123 175.983335 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 10.400000 $1196.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 98 101 208.637182 $10431.8600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 107 110 223.037182 $11832.0600 $53.0500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 15 16 21.811112 $1090.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 30 38 53.100003 $2655.0200 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 10.066667 $2315.3400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 221 232 72.958561 $3648.1100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 11 3.025002 $75.6300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 26 30 40.816670 $2040.8500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 24 30 38.209523 $955.2400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 10 13 18.761113 $938.0700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 13 17 18.116668 $452.9200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 6 9 11.711112 $585.5600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 4.200000 $105.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 21 25 35.894449 $1794.7500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 15 17 19.099999 $477.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 147 207 3829.714305 $95742.8100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1292 1671 12117.885731 $605894.9900 $50.0000
INTR -T1013 INTERPRETER 31 38 275.142857 $13757.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1617 2371 17260.850025 $172608.7000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 193 249 966.647635 $69057.2500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 49 60 258.885714 $14808.2600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 164 216 1022.340500 $73035.8900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 8 29.476192 $1684.8500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.252055 $81.3900 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 5 5 5.000000 $1140.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 11 11 16.733334 $7630.4300 $456.0000
SENS -V5264 EARMOLD 33 41 52.244446 $940.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 367 476 2218.704800 $158504.0100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 11 11 19.571430 $271.6500 $13.8800
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Subtotal (Total Children Is Unduplicated) 1798 5816 38423.219903 $1237292.3000 $32.2000
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Total 6049 38822.240420 $1249124.3600 $32.1800
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Number of Children (Unduplicated) With at Least One Authorization 1881