Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4756 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 43 48 31.461106 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 43 48 31.461106 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 70 119 67.162256 $3257.3900 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.333333 $7.1800 $21.5500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 3.477778 $88.0200 $25.3100
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 12 10.703198 $1230.8700 $115.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 6 5.266667 $268.8700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 85 113 67.351069 $3438.2800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 13 2.855556 $145.7800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 102 130 81.224582 $4146.5100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 10.428571 $532.3800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 184 231 147.140915 $7511.5500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 2 2 1.504110 $76.7800 $51.0500
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Subtotal (Total Children Is Unduplicated) 377 635 398.792479 $20772.2500 $52.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 63 87 56.773365 $283867.5000 $5000.0100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 561 781 1893.279375 $94663.9900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 319 425 991.276988 $49563.8700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 258 368 802.329369 $40116.4500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 633 860 1728.248448 $86412.5600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 624 855 5503.236516 $275161.9400 $50.0000
INTR -T1013 INTERPRETER 34 47 342.313495 $17115.6800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 103 143 1113.323810 $79535.8600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 16.209524 $927.1900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 130 196 1415.750790 $101141.2800 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 12 12 10.862102 $2476.5600 $228.0000
SENS -V5264 EARMOLD 14 15 12.645967 $227.6300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 213 277 2057.614288 $146996.0400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 12.000000 $686.4000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 25.428571 $352.9500 $13.8800
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Subtotal (Total Children Is Unduplicated) 978 4073 15982.292608 $1179475.8800 $73.8000
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Total 4756 16412.546193 $1200248.1300 $73.1300
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Number of Children (Unduplicated) With at Least One Authorization 1033