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 3915 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 7 7 18.938889 $700.7400 $37.0000
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Subtotal (Total Children Is Unduplicated) 34 34 66.949999 $700.7400 $10.4700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 11 11 8.337444 $404.3700 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 12 13 11.422222 $270.7100 $23.7000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.350000 $17.8700 $51.0700
EXIT -EXIT EXIT ASSESSMENT 7 7 11.594444 $579.7200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 2 0.833334 $62.5100 $75.0100
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.483333 $36.2500 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 1.044444 $78.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.561111 $31.1400 $55.5000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 20.433332 $1021.6600 $50.0000
SCREEN-T1023 SCREENING 4 4 23.207143 $1160.3600 $50.0000
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Subtotal (Total Children Is Unduplicated) 41 47 80.266807 $3773.9100 $47.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 3.777778 $18889.0000 $5000.0300
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.088889 $4.4500 $50.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 13 13 11.966667 $2752.3400 $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 133 158 291.721429 $14586.0700 $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 1 1 1.000000 $73.3200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 17 31 147.020636 $3675.5200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 43.740476 $2187.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 96 122 1373.428566 $68671.4500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 8 45.352380 $2267.6200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1292 2852 26086.588356 $260865.9400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 12 98.590475 $7043.3100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.285714 $949.1300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 16 21 210.557143 $15042.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 17.857143 $1020.7100 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.857143 $132.6700 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.377778 $24.5600 $65.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 23 293.860317 $20993.3900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $163.2900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.571429 $326.5800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 4.285714 $59.4900 $13.8800
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Subtotal (Total Children Is Unduplicated) 1322 3834 29838.048664 $477184.9200 $15.9900
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Total 3915 29985.265470 $481659.5700 $16.0600
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Number of Children (Unduplicated) With at Least One Authorization 1341