Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 51
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 1408 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 15 18 34.377780 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 5 5 19.352382 $716.0400 $37.0000
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Subtotal (Total Children Is Unduplicated) 20 23 53.730162 $716.0400 $13.3300
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 26.000000 $1170.0000 $45.0000
EXIT -EXIT EXIT ASSESSMENT 10 10 10.000000 $500.0000 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 3.066667 $230.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 10 10 9.116667 $465.4100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 54 54 62.285714 $3179.6900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 17 17 21.285714 $1086.6400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 23 23 52.857143 $2698.3600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 5.000000 $244.7000 $48.9400
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Subtotal (Total Children Is Unduplicated) 125 129 197.611905 $9987.6400 $50.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 5 5.000000 $25000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 8.088889 $404.4500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 12 22.588888 $1129.4400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 8 8 18.288890 $457.2300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 4 4.966667 $248.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 6 12.866668 $643.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 10 19.884127 $994.2100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 17.377779 $434.4500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 259 308 2945.404753 $147270.3900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 225 286 2797.052373 $199821.6200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 10 14 108.285713 $6193.9500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 83 105 946.482935 $67616.8100 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 2.000000 $912.0000 $456.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 395 475 4456.771408 $318392.0600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.000000 $343.2000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 10 10 105.142856 $1459.3900 $13.8800
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Subtotal (Total Children Is Unduplicated) 714 1256 11476.201946 $771320.8600 $67.2100
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Total 1408 11727.544013 $782024.5400 $66.6800
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Number of Children (Unduplicated) With at Least One Authorization 748