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 4159 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 38 39 78.088889 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 7 7 1809.000000 $66933.0000 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 44 46 1887.088889 $66933.0000 $35.4700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.112329 $5.4500 $48.4900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.233333 $26.8300 $114.9800
EVAL -96111 DEVELOPMENTAL EVALUATION 53 63 51.719785 $2585.9900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 51 52 87.935616 $4396.7900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 20 20 38.005479 $2850.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 21 21 36.296672 $2722.2500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 4.010958 $300.8300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 19 19 30.302151 $1681.7700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 8.000000 $600.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 12 14 3.783333 $193.1400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.216667 $11.0600 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.650000 $33.1800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 11 7.644444 $390.2500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 8 1.650000 $84.2300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 8 3.288888 $167.8900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.094444 $4.8200 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 14 16 4.822222 $246.1700 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 180 250 286.766321 $16901.0700 $58.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 4.230137 $21151.0000 $5000.0700
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 1.255556 $62.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.633333 $81.6700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.611111 $140.5500 $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 493 620 505.044418 $25252.0900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 438 548 716.404771 $17910.1400 $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 439 534 428.822207 $21441.0400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 402 491 612.583334 $15314.5900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 9 82.142858 $2053.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 144 180 1365.490483 $68274.5900 $50.0000
INTR -T1013 INTERPRETER 3 3 56.857143 $2842.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 27 30 206.142858 $14726.8700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 15 18 153.428573 $8776.1200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 8 11 91.357142 $6526.5500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 6 53.714285 $3070.3200 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 2 2 1.455555 $26.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 36 46 329.821432 $23562.4600 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 736 3863 5949.851512 $282254.4800 $47.4400
-------------------------------------------------------------------------------------------------------------------------------------
Total 4159 8123.706722 $366088.5500 $45.0600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 828