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 5200 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 77 105 81.624277 $3958.7800 $48.5000
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 -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.500000 $138.7500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.500000 $412.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 8 8 14.504110 $1087.8100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 26 26 53.504110 $2969.4800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 18.500000 $1387.5000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.544445 $27.8000 $51.0600
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.400000 $20.4200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 11 1.473974 $75.2400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 1.198249 $61.1700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 11 7.738890 $395.0800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.244444 $12.4800 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 3.006926 $153.5100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 7 3.197564 $163.2300 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.400000 $20.4200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 17 22 7.503578 $383.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.123288 $6.2900 $51.0600
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Subtotal (Total Children Is Unduplicated) 223 340 327.472923 $17765.9500 $54.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 33 23.238813 $116194.5000 $5000.0200
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 507 679 1501.194497 $75059.4700 $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 131 175 1286.557137 $64327.8800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 6.066666 $303.3300 $50.0000
INTR -T1013 INTERPRETER 17 24 116.549205 $5827.4600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 567 1211 6521.466608 $65214.6400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 21 29 235.354761 $16813.7500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 21 26 224.827380 $16061.6700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 17.857142 $1020.7200 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 1 1 2.000000 $36.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 28 217.395237 $15530.7300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 12.285714 $877.6900 $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 2 2 17.857143 $247.8600 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 541 1448 410848.262498 $182827.4800 $0.4500
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Subtotal (Total Children Is Unduplicated) 621 4855 423399.347916 $678159.9000 $1.6000
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Total 5200 423741.862108 $695925.8500 $1.6400
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Number of Children (Unduplicated) With at Least One Authorization 647