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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 375 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 12 12 24.146030 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 5 10.133333 $374.9300 $37.0000
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Subtotal (Total Children Is Unduplicated) 16 17 34.279363 $374.9300 $10.9400
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 26.000000 $1170.0000 $45.0000
EXIT -EXIT EXIT ASSESSMENT 15 15 15.857143 $792.8600 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.177778 $9.0800 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 25 26 26.000000 $1327.3000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 9 10 11.857143 $605.3100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.183333 $8.1700 $44.5400
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Subtotal (Total Children Is Unduplicated) 56 59 85.075397 $4167.9500 $48.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.933333 $96.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7 7 14.588887 $729.4400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 6 6.877778 $171.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 5 3.833334 $191.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 8 15.095237 $754.7600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 11 16.022220 $801.1000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 4.011111 $100.2800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 58 71 671.457141 $33572.8800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 52 64 689.152380 $49233.0500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 3 20.000000 $1144.0000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 23 30 210.692857 $15051.9000 $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 70 84 749.999996 $53580.0300 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 0.428571 $15.8600 $37.0000
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Subtotal (Total Children Is Unduplicated) 184 299 2407.092845 $161355.5700 $67.0300
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Total 375 2526.447605 $165898.4500 $65.6600
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Number of Children (Unduplicated) With at Least One Authorization 219