Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 07-01-19 and 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 6632 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 25 25 31.677777 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 16.333333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 40 40 96.472223 $3569.4800 $37.0000
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Subtotal (Total Children Is Unduplicated) 67 67 144.483333 $3569.4800 $24.7100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 14 10.648555 $516.4600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 22 22 11.988890 $166.2900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 106 116 89.383332 $2118.3800 $23.7000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.350000 $17.8700 $51.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 2.844444 $128.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.216667 $139.9200 $115.0000
EXIT -EXIT EXIT ASSESSMENT 8 8 13.594444 $679.7200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 5 4.455556 $334.1700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 4 3.405555 $255.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 7 6.011112 $450.8400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 3.694444 $205.0400 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 20.433332 $1021.6600 $50.0000
SCREEN-T1023 SCREENING 8 11 47.121430 $2356.0800 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.555556 $79.4100 $51.0500
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Subtotal (Total Children Is Unduplicated) 172 206 222.703317 $8822.7400 $39.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 13 11.588890 $57945.0000 $5000.0500
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 0.955556 $47.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 5.803175 $290.1600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 5.772222 $413.3500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 42 42 33.344446 $7669.2600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 66 76 68.557937 $3427.9000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 2.005556 $100.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 6 4.500000 $112.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 68 80 210.494445 $10524.7300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 9.857143 $246.4300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 153 199 438.174603 $21908.7300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 15 15 27.638888 $1381.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 9 9 43.870635 $1096.7700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 112 144 332.330156 $16616.4900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 10 10 10.622222 $531.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.500000 $12.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 133 159 294.521429 $14726.0700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 24 25 21.616666 $1080.8300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 14.666666 $366.6700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 9 9 17.233333 $1263.5500 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 66 127 593.712699 $14842.8400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 43.740476 $2187.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1032 1690 17488.780151 $874439.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 122 125 695.433332 $34771.6900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1293 2854 26101.883594 $261018.8900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 123 203 2027.973801 $144878.4700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 12 12 81.942856 $5853.9900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 15 15 189.604763 $10845.4000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 34.857143 $1993.8300 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 23.714286 $1694.1500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 10 10 59.414286 $4244.5600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 124 197 2361.064279 $168674.4700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 12 12 100.033334 $7146.3900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 7 80.666666 $4610.9000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 6.866667 $392.5000 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 14 15 55.838095 $3989.0800 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.377778 $24.5600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.076712 $34.9800 $455.9300
SENS -V5264 EARMOLD 3 3 2.908981 $52.3600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 147 214 2113.058733 $150956.9100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 21 21 105.023809 $7502.8900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 21 22 102.864285 $7348.6300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 88.876190 $1233.6000 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $31.7300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1429 6359 53917.052598 $1848987.0200 $34.2900
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Total 6632 54284.239248 $1861379.2400 $34.2900
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Number of Children (Unduplicated) With at Least One Authorization 1448