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 4299 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 39 39 42.633332 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 11 11 4386.000000 $162282.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 49 50 4428.633332 $162282.0000 $36.6400
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.022222 $117.5500 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 39 47 24.713390 $1235.6700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 50 54 71.348706 $3567.4300 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 23 23 42.010958 $3150.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 21 21 40.005479 $3000.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 21 22 36.021916 $1999.2200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 11 13 3.377778 $172.4400 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 1.205555 $61.5400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 12 5.105556 $260.6400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 8 1.827778 $93.3100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 9 3.149999 $160.8000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 21 6.238888 $318.4900 $51.0500
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Subtotal (Total Children Is Unduplicated) 164 241 246.200447 $14897.1200 $60.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.128767 $5644.0000 $5000.1500
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 2.044444 $102.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.511111 $25.5600 $50.0000
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 540 657 594.205522 $29710.1100 $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 473 558 496.738869 $24836.8500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 448 541 725.150008 $18128.7700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 9 69.428571 $1735.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 135 167 1313.628572 $65681.5100 $50.0000
INTR -T1013 INTERPRETER 1 1 12.571429 $628.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 38 42 219.714285 $15696.4100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 22 27 211.428571 $12093.7200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 11 14 80.357144 $5740.7300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 7 61.000000 $3486.7700 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 1 1 1.022222 $18.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 35 42 339.571430 $24258.9900 $71.4400
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Subtotal (Total Children Is Unduplicated) 798 4008 6339.613610 $279932.9100 $44.1600
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Total 4299 11014.447389 $457112.0300 $41.5000
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Number of Children (Unduplicated) With at Least One Authorization 884