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 6801 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
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Subtotal (Total Children Is Unduplicated) 8 8 5.781690 $30.0100 $5.1900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 75 98 57.246271 $2776.4600 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.000000 $47.4000 $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
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 21 21 34.516437 $2588.7400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 19 19 31.015068 $2326.1300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 55 55 88.047942 $4886.6700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 20 20 38.005479 $2850.4100 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.477778 $24.3900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.116667 $57.0100 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 6 0.824658 $42.1000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 8 8 5.695510 $290.7600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 10 5.044445 $257.5200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 1.022222 $52.1800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 1.550685 $79.1600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 4 3.511111 $179.2400 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.138585 $7.0800 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 15 17 6.338508 $323.5800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.128767 $6.5800 $51.0600
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Subtotal (Total Children Is Unduplicated) 291 412 426.567216 $24249.5600 $56.8500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 17 24 11.012634 $55064.5000 $5000.1200
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 660 834 1943.490906 $97174.8400 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 158 192 1550.938097 $77547.0200 $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 22 26 205.030953 $14647.4400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 20 27 228.004761 $16288.6700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 8.571429 $489.9400 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 26 198.214937 $14160.4900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.285714 $31.7300 $13.8800
TRAV -TRAVS Travel by mile 851 2317 558151.568020 $248377.4500 $0.4500
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Subtotal (Total Children Is Unduplicated) 887 6381 573292.498664 $744772.0200 $1.3000
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Total 6801 573724.847570 $769051.5900 $1.3400
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Number of Children (Unduplicated) With at Least One Authorization 904