Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 9850 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 28 31 18.299999 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 28 31 18.299999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $17.9200 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1167 1232 1239.576189 $26464.9500 $21.3500
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 7 7.000000 $315.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 8 8.000000 $920.0000 $115.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 83 85 83.588889 $4267.2100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 27 28 27.522222 $1405.0100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 100 114 113.688889 $5803.8200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 3 3 3.000000 $153.1500 $51.0500
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Subtotal (Total Children Is Unduplicated) 1280 1478 1483.376189 $39347.0600 $26.5300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 6.472223 $32361.5000 $5000.0600
AUDE -V5160 DISPENSING FEE BINAURAL 11 11 10.161111 $2337.0500 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1272 1640 1373.373725 $68668.2700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 0.822223 $20.5600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 184 211 176.416657 $8820.7900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 307 356 318.146009 $15907.1900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 930 1140 866.338045 $43316.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 0.822223 $20.5600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 0.011111 $0.2800 $24.9800
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1858 2858 25304.036118 $1265202.0700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 418 568 3493.097644 $249546.9000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 16.571429 $947.8800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 561 713 4036.166692 $288343.6600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 3 7.928571 $453.2000 $57.1600
SENS -V5264 EARMOLD 1 1 1.000000 $18.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 602 812 5194.561930 $371099.4700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 8 46.571428 $646.4100 $13.8800
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Subtotal (Total Children Is Unduplicated) 2410 8341 40852.497139 $2347710.4400 $57.4700
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Total 9850 42354.173327 $2387057.4900 $56.3600
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Number of Children (Unduplicated) With at Least One Authorization 2450