Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 6743 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 10 10 29.766667 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 0.922222 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 8 8 79.134921 $2928.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 19 20 109.823810 $2928.0000 $26.6600
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.511111 $28.8700 $56.4900
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.022222 $46.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.022222 $117.5500 $115.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 5 1.727778 $88.2000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 101 107 71.569840 $3653.6300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 9 11 2.455555 $125.3500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.494444 $25.2400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 78 91 83.515077 $4263.4200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.122222 $6.2400 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 129 143 82.369841 $4204.9700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 4 0.861112 $42.1500 $48.9500
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Subtotal (Total Children Is Unduplicated) 225 366 245.671424 $12601.6300 $51.2900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 5 1.044446 $52.2300 $50.0100
CONOF -CONOF CONSULT, OT, FACE TO FACE 370 434 275.680924 $13783.9200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.172222 $4.3100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 41 49 32.982534 $1649.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 790 980 627.480894 $31373.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 11 11 7.344443 $183.6100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 141 210 1021.272220 $25531.8600 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 4.000000 $200.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1548 1982 16231.751549 $811588.5800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1548 2003 16262.695991 $162627.1600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 152 212 727.057955 $51940.9100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 14 14 37.639682 $2152.9900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 105 150 852.547228 $60905.9700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 9 52.785714 $3017.2300 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.252055 $114.9600 $456.0800
SENS -V5264 EARMOLD 1 1 1.022222 $18.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 182 253 1001.473430 $71545.1800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 20 22 95.785716 $1329.5000 $13.8800
TRAV -TRAVS Travel by mile 19 19 14675.142856 $6530.4400 $0.4500
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Subtotal (Total Children Is Unduplicated) 1648 6357 51908.132081 $1244550.1100 $23.9800
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Total 6743 52263.627315 $1260079.7300 $24.1100
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Number of Children (Unduplicated) With at Least One Authorization 1657