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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3918 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 5 108.103176 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5 5 108.103176 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 58 83 73.166985 $3548.6100 $48.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 2.000000 $90.0000 $45.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 4 5 2.194445 $109.7300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 70 70 80.027397 $4001.3700 $50.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.500000 $787.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 21 21 45.000000 $2497.5000 $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 1 1 10.571429 $539.6700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.511111 $77.1400 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 6 1.005480 $51.3300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 1.511111 $77.1400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 4.411111 $225.1900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.158904 $59.1600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 2.500000 $127.6300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.511111 $26.0900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 17 9.119103 $465.5400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.466667 $23.8300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 161 241 278.154854 $14926.3800 $53.6600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 27 20.668190 $103341.0000 $5000.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 2 2.000000 $460.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 86 100 101.265644 $5063.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 4 3.673611 $183.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 5 2.079167 $51.9800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 402 517 1198.707553 $59935.6500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 4.533334 $226.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 5.500000 $137.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 220 272 545.747640 $27287.4900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 4 4 9.952381 $497.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 8 17.066668 $426.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 53 107.690481 $5384.5500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 5.133334 $128.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 368 446 898.757184 $44938.0800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 7 7 14.666668 $733.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 8 18.433335 $460.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 102 142 1063.738087 $53186.9900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 3.066667 $153.3400 $50.0000
INTR -T1013 INTERPRETER 16 28 151.116436 $7555.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 448 966 5540.057860 $55400.7000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 17 23 193.095238 $13794.7300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 13 18 136.571430 $9756.6500 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 2.000000 $912.0000 $456.0000
SENS -V5264 EARMOLD 1 2 4.000000 $72.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 25 178.642856 $12762.2400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 1.428571 $19.8300 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 1.000000 $37.0000 $37.0000
TRAV -TRAVS Travel by mile 410 1003 300411.903722 $133683.3000 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 502 3672 310643.496057 $536662.8700 $1.7300
-------------------------------------------------------------------------------------------------------------------------------------
Total 3918 311029.754087 $551589.2500 $1.7700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 531