Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 7500 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 42 42 48.966666 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 117 132 30970.698412 $1145915.8400 $37.0000
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Subtotal (Total Children Is Unduplicated) 147 174 31019.665078 $1145915.8400 $36.9400
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.274277 $57.3400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 4.599999 $528.9900 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 42 50 27.718946 $1385.9500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 53 57 76.348706 $3817.4300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 22.011111 $1650.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 13 20.027701 $1502.0800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 8 12.016590 $666.9200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 272 273 530.043832 $39753.3000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 224 226 436.043832 $32703.3000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 87 87 160.038353 $12002.8900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 91 92 170.038353 $9437.1400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 22 22 44.000000 $3300.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 101 122 39.071422 $1994.5600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 41 46 17.266664 $881.4500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 113 129 58.799997 $3001.7300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 54 60 13.716668 $700.2400 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 13 4.594444 $234.5400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 53 65 24.455556 $1248.4600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.511111 $77.1400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 288 324 111.726180 $5703.5800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 0.955555 $46.7600 $48.9400
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Subtotal (Total Children Is Unduplicated) 884 1615 1780.603741 $121012.2000 $67.9600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 3.128767 $15644.0000 $5000.0500
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 2.044444 $102.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 2.055555 $102.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.122222 $258.1100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 15 17 10.827779 $541.4000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 4.316666 $107.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 540 658 594.972189 $29748.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 483 593 838.077786 $20951.9700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 294 652 494.211063 $24710.3200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 176 362 529.027795 $13225.7400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 90 190 161.522208 $8076.0400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 56 116 172.129368 $4303.2400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 473 559 497.505536 $24875.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 448 541 725.150008 $18128.7700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 13 17 130.285713 $3257.1500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 613 759 6383.279373 $319164.2900 $50.0000
INTR -T1013 INTERPRETER 1 1 12.571429 $628.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 231 276 1575.394436 $112546.3300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 237 322 2615.214290 $149590.3900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 89 115 835.955951 $59720.7800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 71 94 768.464284 $43925.4900 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 5.022222 $2290.1200 $456.0000
SENS -V5264 EARMOLD 6 7 8.199998 $147.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 331 409 3407.319039 $243419.1600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.428571 $81.7200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 23.428571 $325.1900 $13.8800
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Subtotal (Total Children Is Unduplicated) 1083 5711 19803.655263 $1096100.8900 $55.3500
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Total 7500 52603.924082 $2363028.9300 $44.9200
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Number of Children (Unduplicated) With at Least One Authorization 1267