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: 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 7629 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 32 37 37.936508 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 111 134 35008.300000 $1295307.1000 $37.0000
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Subtotal (Total Children Is Unduplicated) 136 171 35046.236508 $1295307.1000 $36.9600
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 1.011112 $45.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 2.788890 $320.7400 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 38 44 43.248555 $2162.4400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 77 79 125.744445 $6287.2300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 15 15 30.000000 $2250.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 16.005479 $1200.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 221 222 434.044138 $32553.3200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 173 173 330.340810 $24775.5700 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 68 69 131.016437 $9826.2400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 84 85 158.313109 $8786.3800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 17 17 34.000000 $2550.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 89 99 34.796216 $1776.4000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 22 30 9.455555 $482.7000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 135 153 73.645257 $3759.6900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 52 57 12.377783 $631.9100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 11 3.638889 $185.7700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 59 65 32.255561 $1646.6700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 0.788890 $40.2800 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 294 338 111.077011 $5670.6100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 1.933334 $86.1300 $44.5500
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Subtotal (Total Children Is Unduplicated) 806 1491 1604.486950 $106310.3000 $66.2600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 3 0.677778 $3389.0000 $5000.1600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 1.266668 $63.3400 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.366667 $68.3400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.488889 $572.4500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 22 24 18.793255 $939.6700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 6 6 3.761112 $94.0300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 524 675 571.125378 $28556.1800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 477 617 834.566670 $20864.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 295 663 441.799996 $22089.9800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 189 392 463.216670 $11580.4300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 70 163 119.727779 $5986.4000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 46 110 150.249999 $3756.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 465 578 477.514269 $23875.6300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 450 563 708.650800 $17716.2800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 17 128.607142 $3215.1800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 606 777 6323.688901 $316184.4300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 65 66 61.142855 $3057.1600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 203 248 1473.836510 $105290.9000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 11 11 15.999999 $1143.0300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 239 308 2359.016667 $134935.7400 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 17 17 16.428571 $939.7200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 79 103 750.579761 $53621.4400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 8 8 7.000000 $500.0800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 62 86 698.571426 $39930.3400 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 4 2.857143 $163.3200 $57.1600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 1.714286 $97.9900 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 1.011112 $461.1100 $456.0400
SENS -V5264 EARMOLD 5 6 6.022223 $108.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 324 421 3116.211906 $222622.1100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 31 32 32.428572 $2316.7100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.142857 $65.3700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 12.000000 $857.2800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 22.571428 $313.2900 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 43 53 50.485712 $1868.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 1044 5967 18877.523001 $1027471.6900 $54.4300
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Total 7629 55528.246459 $2429089.0900 $43.7500
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Number of Children (Unduplicated) With at Least One Authorization 1186