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: 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 6823 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 1 1 0.355556 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 3.553968 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 53 56 84.734922 $3135.2000 $37.0000
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Subtotal (Total Children Is Unduplicated) 56 59 88.644446 $3135.2000 $35.3700
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.116667 $6.5900 $56.5100
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.233333 $10.5000 $44.9900
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.233333 $26.8300 $114.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.505556 $25.8100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 145 163 96.169063 $4909.5100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 4 2.161112 $110.3300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 78 94 50.011121 $2553.1200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.894444 $45.6600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 154 189 86.554322 $4418.6900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 7 2.866668 $127.7200 $44.5500
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Subtotal (Total Children Is Unduplicated) 258 463 239.745619 $12234.7500 $51.0300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 8 23 7.649998 $382.4900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 487 573 375.519038 $18775.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 66 80 60.411107 $3020.5400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 872 1071 670.707137 $33535.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.011111 $25.2800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 132 165 1403.696824 $35092.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1487 1891 15647.265853 $782363.2500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 9 38.571429 $1928.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1511 1928 15929.253153 $159292.5200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 153 190 964.591271 $68910.4200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.285714 $234.7300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 5.714286 $326.8600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 87 117 720.710319 $51487.5400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 52.000000 $2972.3200 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.057534 $26.2200 $455.7300
SENS -V5264 EARMOLD 1 1 0.233333 $4.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 192 244 1411.942860 $100869.1800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 4.714286 $65.4300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1634 6301 37297.335253 $1259313.2100 $33.7600
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Total 6823 37625.725318 $1274683.1600 $33.8800
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Number of Children (Unduplicated) With at Least One Authorization 1652