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 4069 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 1 1 0.411111 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 18 18 10.433333 $386.0300 $37.0000
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Subtotal (Total Children Is Unduplicated) 20 20 11.200000 $386.0300 $34.4700
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 27 29 15.061910 $768.9400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.505556 $25.8100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 17 21 8.883335 $453.5000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 48 55 23.675404 $1208.6700 $51.0500
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Subtotal (Total Children Is Unduplicated) 67 110 49.215094 $2526.6600 $51.3400
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 156 200 1553.476192 $77673.7900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1511 1928 15929.253153 $159292.5200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 11 80.238095 $5732.2200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 11 17 125.142857 $8940.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 26.000000 $1486.1600 $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 26 31 223.071428 $15936.2200 $71.4400
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Subtotal (Total Children Is Unduplicated) 1524 3939 19052.770983 $324831.0800 $17.0500
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Total 4069 19113.186077 $327743.7700 $17.1500
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Number of Children (Unduplicated) With at Least One Authorization 1545