Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 3948 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 6 6 33.563492 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 1.088889 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.133333 $4.9300 $36.9900
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Subtotal (Total Children Is Unduplicated) 9 9 34.785714 $4.9300 $0.1400
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 0.511111 $28.8700 $56.4900
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 1.022222 $46.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 1.022222 $117.5500 $115.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.411111 $20.9900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 33 36 28.253173 $1442.3200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 3 0.894444 $45.6600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 25 29 36.657936 $1871.3900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 49 58 43.214285 $2206.0900 $51.0500
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Subtotal (Total Children Is Unduplicated) 75 133 111.986504 $5778.8600 $51.6000
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 6 11 4.238889 $211.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 423 505 300.634088 $15031.5200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 52 61 49.420632 $2471.0100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 842 1022 595.334068 $29766.4100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 4 2.188889 $54.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 10.428571 $260.7200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 153 199 1604.265065 $80213.3800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1513 1928 15722.183196 $157222.0500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 9 70.928572 $5067.1500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 13.142857 $751.7700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 16 21 147.357143 $10527.1900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 12.142857 $694.0900 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 0.252055 $114.9100 $455.9000
SENS -V5264 EARMOLD 1 2 1.022222 $18.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 25 32 237.714284 $16982.3500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 7.571429 $105.0900 $13.8800
TRAV -TRAVS Travel by mile 5 5 80.428572 $35.7900 $0.4500
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Subtotal (Total Children Is Unduplicated) 1531 3806 18859.253389 $319528.4700 $16.9400
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Total 3948 19006.025607 $325312.2600 $17.1200
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Number of Children (Unduplicated) With at Least One Authorization 1550