Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 8669 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.811111 $30.0100 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 7 7 4.970579 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.166667 $6.1700 $37.0100
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Subtotal (Total Children Is Unduplicated) 9 9 5.948357 $36.1800 $6.0800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 98 126 77.327549 $3750.4200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.252055 $14.2400 $56.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 2.222222 $52.6700 $23.7000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EXIT -EXIT EXIT ASSESSMENT 137 137 145.601369 $7280.0700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 6.005479 $450.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 135 135 237.079447 $17780.9800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 63 63 101.058900 $7579.4300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 195 196 339.292162 $18830.7400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 67 67 129.510958 $9713.3300 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 10 10 16.535245 $844.1200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 7 8 3.261111 $166.4800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 22 24 7.182346 $366.6700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 50 55 31.395207 $1602.7300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 24 29 10.985312 $560.8000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 7 2.344444 $119.6800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 19 21 8.859969 $452.3000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 53 60 33.936911 $1732.4900 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 2.244141 $114.5700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.400000 $20.4200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 81 87 76.503305 $3905.5000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.545434 $27.8500 $51.0600
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Subtotal (Total Children Is Unduplicated) 531 1051 1246.834759 $76212.2600 $61.1200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 122 158 110.962656 $554817.5000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.504110 $25.2100 $50.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 108 118 154.236360 $7711.8100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 3 3.600000 $90.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 661 835 1946.557573 $97328.1800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 8 17.800000 $445.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 344 424 895.728610 $44786.6100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 7.833333 $195.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 66 78 152.233338 $7611.6900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 592 701 1413.657216 $70683.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 10 26.400002 $660.0100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.285714 $240.9100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 14 1534.285716 $38357.1400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 699 852 6920.766655 $346038.8100 $50.0000
INTR -T1013 INTERPRETER 29 53 133.962427 $6698.1300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 747 1530 8184.140103 $81841.5500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 138 166 1460.675868 $104350.7700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 4 32.000000 $1830.4000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 136 164 1472.472618 $105193.5100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 8 39.919765 $2281.8200 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 136 155 1340.681276 $95778.3400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 17.714286 $245.8700 $13.8800
TRAV -TRAVS Travel by mile 851 2318 558940.139449 $248728.3700 $0.4500
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Subtotal (Total Children Is Unduplicated) 906 7609 584809.557075 $1815940.6500 $3.1100
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Total 8669 586062.340191 $1892189.0900 $3.2300
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Number of Children (Unduplicated) With at Least One Authorization 917