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 3953 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 1 1 12.714286 $470.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 13 13 43.403175 $470.4300 $10.8400
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 1 1 0.227778 $11.6300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 25 27 19.055555 $972.7800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.277778 $14.1800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 22 27 34.278570 $1749.9100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 46 50 30.227777 $1543.1200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.338889 $16.5900 $48.9400
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Subtotal (Total Children Is Unduplicated) 75 111 86.961902 $4500.6400 $51.7500
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 12 13 59.700793 $1492.5200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 181 224 1823.196027 $91159.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1548 2003 16262.695991 $162627.1600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 21 107.499998 $7679.8100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 8.571428 $490.2900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 19 22 184.071428 $13150.0800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.500000 $200.0600 $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 34 37 231.571429 $16543.4900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 5 45.285714 $628.5700 $13.8800
TRAV -TRAVS Travel by mile 19 19 14675.142856 $6530.4400 $0.4500
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Subtotal (Total Children Is Unduplicated) 1571 3829 34347.215404 $347682.6400 $10.1200
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Total 3953 34477.580481 $352653.7100 $10.2300
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Number of Children (Unduplicated) With at Least One Authorization 1576