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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4738 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 175 185 160.435702 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 175 185 160.435702 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 71 99 74.114914 $3594.5700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 9 10 12.142857 $337.9400 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 13 4.526029 $520.4800 $115.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 77 97 57.826483 $2952.0400 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 122 170 101.596043 $5186.4700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 117 152 80.971006 $4133.5800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.816667 $41.6900 $51.0500
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Subtotal (Total Children Is Unduplicated) 324 544 332.993999 $16817.8200 $50.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 67 93 68.238431 $341192.5000 $5000.0100
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.756165 $403.9300 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 613 859 1409.298394 $70464.8300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 299 392 581.438096 $29071.9100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 246 345 545.618251 $27280.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 600 825 1158.302356 $57914.9800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 674 959 5744.099980 $287205.3200 $50.0000
INTR -T1013 INTERPRETER 5 6 46.336509 $2316.8300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 82 107 713.477782 $50970.9000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 142 215 1391.920628 $99438.9600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 8.866667 $506.8200 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 14 16 5.378084 $1226.1800 $228.0000
SENS -V5264 EARMOLD 13 15 5.282194 $95.0800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 127 172 1036.760320 $74066.1600 $71.4400
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Subtotal (Total Children Is Unduplicated) 970 4009 12716.773857 $1042155.2900 $81.9500
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Total 4738 13210.203558 $1058973.1100 $80.1600
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Number of Children (Unduplicated) With at Least One Authorization 1114