Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 6754 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 5 5 15.041269 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 15.041269 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 97 137 104.691477 $5077.5300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 2 3 0.366666 $18.3300 $49.9900
EXIT -EXIT EXIT ASSESSMENT 110 111 111.142402 $5557.1200 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.500000 $337.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.500000 $249.7500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 26 26 52.000000 $3900.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.500000 $637.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 28 28 47.521916 $3564.1400 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 13 13 24.504110 $1837.8100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 80 81 160.455967 $8905.3100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 9 9 18.000000 $999.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 18 42.000000 $3150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 14 18 18.297188 $934.0900 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.150685 $7.6900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 6 4.027778 $205.6200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 23 29 16.085098 $821.1500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 48 56 42.922905 $2191.2000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 22 29 14.015987 $715.5400 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.244444 $63.5300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 19 20 9.332954 $476.4500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 51 64 46.663244 $2382.1600 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 8 9 6.088204 $310.8000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 1.375342 $70.2100 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 81 99 57.119617 $2915.9500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 4.112329 $209.9300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.123288 $6.2900 $51.0600
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 4.081801 $181.8400 $44.5500
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Subtotal (Total Children Is Unduplicated) 380 788 815.823402 $46450.9800 $56.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 119 166 121.025733 $605127.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.505556 $25.2800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 102 121 164.745335 $8237.2500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 3.849999 $192.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 17 17 15.720835 $393.0300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 508 680 1504.227830 $75211.1400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 3.033333 $151.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.071429 $26.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 285 364 846.490444 $42324.3600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 6 10.766667 $269.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 53 69 143.133326 $7156.6300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.033333 $75.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 466 596 1148.618987 $57430.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 18.399998 $460.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 533 689 5316.519028 $265825.9900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 9 78.566666 $3928.3300 $50.0000
INTR -T1013 INTERPRETER 17 24 116.549205 $5827.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 567 1212 6527.180894 $65271.7800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 121 163 1240.288201 $88606.2000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 30.285714 $2163.6100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 8 78.142857 $4469.7700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 124 161 1312.729252 $93781.4000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 7 7 61.571429 $4398.6500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 8 63.406457 $3624.3200 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.249315 $56.8400 $227.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 3 3 3.370167 $60.6600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 134 164 1274.151693 $91025.3800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 34.714285 $2479.9900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.571429 $375.8800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 15 15 131.428571 $1824.2300 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 541 1449 411628.262498 $183174.5800 $0.4500
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Subtotal (Total Children Is Unduplicated) 663 5961 431891.610466 $1614699.8400 $3.7400
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Total 6754 432722.475137 $1661150.8200 $3.8400
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Number of Children (Unduplicated) With at Least One Authorization 703