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: 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 6661 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 35 38 72.177776 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 98 113 27015.461904 $999572.0900 $37.0000
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Subtotal (Total Children Is Unduplicated) 127 151 27087.639680 $999572.0900 $36.9000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.011111 $45.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.011111 $116.2800 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 26 26 21.109440 $1055.4900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 99 102 182.000000 $9100.0000 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 9 9 18.000000 $1350.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 6.011111 $333.6200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 15 30.000000 $2250.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 214 218 423.032874 $31727.4800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 30 30 58.005479 $4350.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 94 97 191.005479 $14325.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $777.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 94 94 184.010958 $10212.6100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 87 105 31.731068 $1619.9100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 15 7.533337 $384.6000 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
OCTH -97167 OT EVAL HIGH COMPLEXITY 119 147 66.001560 $3369.4600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 35 41 87.750006 $4479.6700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 3.438891 $175.5700 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
PSTH -97163 PT EVAL HIGH COMPLEXITY 50 63 32.088894 $1638.1600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 4 2.261111 $115.4300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 258 294 123.370414 $6298.2100 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 2.811111 $143.5100 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 2.461111 $125.6400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 8 2.538889 $113.1100 $44.5500
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Subtotal (Total Children Is Unduplicated) 734 1324 1533.411733 $97068.6800 $63.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 6 2.516668 $12584.0000 $5000.2600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.011111 $50.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.011111 $50.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 3 3.033334 $697.6800 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 19 19.219410 $960.9900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 5 2.788889 $69.7200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 477 600 472.410297 $23620.4100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 0.305556 $15.2800 $50.0100
CONIP -CONIP CONSULT, ITDS PHONE 413 520 727.099997 $18177.5100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 250 550 364.250786 $18212.5100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 0.277778 $13.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 160 309 377.885718 $9447.1500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 68 144 107.961116 $5398.0800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 2 0.677778 $33.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 52 118 115.805560 $2895.1500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 409 514 402.316649 $20115.7500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 0.583334 $29.1700 $50.0100
CONSP -CONSP CONSULT, SLP, PHONE 382 474 598.776195 $14969.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 13 90.464285 $2261.6100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 512 648 5027.223807 $251361.1500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 82 87 849.857142 $42492.8600 $50.0000
INTR -T1013 INTERPRETER 2 2 22.571429 $1128.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 151 182 1213.069045 $86661.6500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 16 16 160.033332 $11432.7900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 184 257 1909.254757 $109209.3900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 22 22 193.285715 $11055.9400 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 9.000000 $642.9600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 13.000000 $928.7200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 63 78 616.964284 $44075.9300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 7 7 76.571427 $5470.2700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 60 81 663.538096 $37927.8400 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 5 52.285715 $2988.6500 $57.1600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 13.000000 $743.0800 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.011111 $461.0600 $456.0000
SENS -V5264 EARMOLD 3 4 5.055556 $91.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 316 378 3032.233331 $216622.7700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 42 45 449.999999 $32147.9900 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 6 6 57.428572 $4102.6900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 6 6 36.428571 $2602.4700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 24.714286 $343.0300 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.857143 $25.7800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 55 68 645.881747 $23897.6400 $37.0000
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Subtotal (Total Children Is Unduplicated) 958 5186 18362.660637 $1016017.5200 $55.3300
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Total 6661 46983.712050 $2112658.2900 $44.9700
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Number of Children (Unduplicated) With at Least One Authorization 1110