Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 7413 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 42 43 83.300000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 120 131 33086.526986 $1224201.5000 $37.0000
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Subtotal (Total Children Is Unduplicated) 155 174 33169.826986 $1224201.5000 $36.9100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.112329 $5.4500 $48.4900
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 1.981128 $89.1500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 7 5.633332 $647.8200 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 59 71 58.685692 $2934.2900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 51 52 87.935616 $4396.7900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 16 30.011111 $2250.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 13 22.016590 $1651.2500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 5 8.005479 $444.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 265 265 520.164773 $39012.3700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 235 235 453.324067 $33999.3200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 40 40 72.021916 $5401.6500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 82 83 141.345983 $7844.7100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 72 72 138.153815 $10361.5400 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 126 153 42.021436 $2145.2300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.216667 $11.0600 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 44 50 19.577776 $999.4400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 97 111 54.429015 $2778.5900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 83 94 23.566671 $1203.1000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.127778 $6.5200 $51.0600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 15 6.049999 $308.8500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 53 61 25.876940 $1321.0200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.205556 $10.5000 $51.0600
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 0.327778 $16.7300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 272 315 101.058732 $5159.0600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 6 0.866666 $42.4100 $48.9400
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Subtotal (Total Children Is Unduplicated) 862 1680 1823.716845 $123791.9800 $67.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 5.230137 $26151.0000 $5000.0600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 4 2.055556 $102.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 6 3.677778 $183.8900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 3.677778 $845.8900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 12 16 9.266666 $463.3300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 5.283334 $132.0900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 494 621 506.611085 $25330.4300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 439 549 717.971438 $17949.3100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 286 652 497.583297 $24878.9900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 169 342 469.724609 $11743.1300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 92 214 170.585703 $8529.2400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 56 121 184.412707 $4610.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 440 535 430.388874 $21519.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 402 491 612.583334 $15314.5900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 17 149.000001 $3725.0100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 570 721 5381.207973 $269060.6000 $50.0000
INTR -T1013 INTERPRETER 3 3 56.857143 $2842.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 213 246 1398.767466 $99928.0200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 223 293 2309.920242 $132127.5300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 104 134 972.705554 $69490.1200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 72 100 719.890478 $41148.9800 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 7 8.477018 $3865.5600 $456.0000
SENS -V5264 EARMOLD 8 11 11.455554 $206.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 346 453 3390.461917 $242214.7600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 13.142857 $751.7700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 19.142858 $265.7000 $13.8800
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Subtotal (Total Children Is Unduplicated) 1039 5559 18051.081357 $1023609.4500 $56.7100
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Total 7413 53044.625188 $2371602.9300 $44.7100
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Number of Children (Unduplicated) With at Least One Authorization 1206