Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 6287 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 67 78 51.977775 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 67 78 51.977775 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 9 13 4.461110 $216.3600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $112.9800 $56.4900
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.222222 $10.0000 $45.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 8 2.638890 $134.7200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 0.650000 $33.1800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 277 337 134.143642 $6848.0000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 8 2.505556 $127.9100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 0.511112 $26.1000 $51.0600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 3 0.933333 $47.6400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 212 272 136.334910 $6959.8600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 3 0.833333 $42.5400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 141 175 94.608727 $4829.7600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.327777 $16.7300 $51.0400
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 17 19 6.799999 $332.7900 $48.9400
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Subtotal (Total Children Is Unduplicated) 502 848 386.970611 $19738.5700 $51.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 58 186 82.476190 $4123.8200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 7 4.577778 $228.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5 5 4.100000 $205.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 5 15.720634 $786.0300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 4 2.288889 $114.4500 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 213 301 2500.857122 $62521.5200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1415 1848 16436.732415 $821837.6600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1429 1940 16993.173681 $169931.9600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 172 207 1550.692045 $110781.5400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 176 218 1522.752380 $87101.5100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 123 160 1333.015863 $95230.8500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 155 200 1397.364286 $79873.4100 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 1 1 0.477778 $8.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 59 70 458.285711 $32739.9700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 9 9 88.428571 $5058.1100 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 151 195 1223.861914 $16987.2000 $13.8800
TRAV -TRAVS Travel by mile 1 1 2.142857 $0.9500 $0.4500
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Subtotal (Total Children Is Unduplicated) 1780 5361 43620.948114 $1493267.4500 $34.2300
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Total 6287 44059.896500 $1513006.0300 $34.3400
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Number of Children (Unduplicated) With at Least One Authorization 1837