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 5310 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 27 30 17.277777 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 30 17.277777 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 199 207 205.433334 $4386.0000 $21.3500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 32 33 33.000000 $1684.6500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 32 33 33.000000 $1684.6500 $51.0500
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Subtotal (Total Children Is Unduplicated) 249 278 276.433334 $8010.5500 $28.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.116667 $5583.5000 $5000.1500
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $690.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1271 1639 1372.707058 $68634.9400 $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 1139 864.304712 $43214.9900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 0.822223 $20.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 621 947 8763.002380 $438150.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 139 181 1196.852389 $85503.1600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.428571 $253.3200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 159 200 1240.432552 $88616.4600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 5.714286 $326.6300 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 235 311 2155.607151 $153996.6200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 22.285714 $309.3300 $13.8800
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Subtotal (Total Children Is Unduplicated) 1846 5002 16125.658592 $910048.1800 $56.4300
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Total 5310 16419.369703 $918058.7300 $55.9100
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Number of Children (Unduplicated) With at Least One Authorization 1892