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: 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 2548 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 6 6 4.044444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 6 4.044444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 288 294 297.330158 $6984.2800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 30.285714 $1546.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 8 19.620635 $960.2400 $48.9400
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Subtotal (Total Children Is Unduplicated) 308 318 358.236507 $10014.9800 $27.9600
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 5.000000 $1150.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 444 520 467.303146 $23365.0200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 38 39 30.405555 $1520.2800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 147 165 119.141256 $5957.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 211 232 197.517451 $9875.8200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 583 691 6767.747184 $338387.5400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 75 86 495.355561 $35388.1800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 53 61 331.530165 $18963.5100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 171 207 1152.053196 $82302.6200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 4.928571 $281.7200 $57.1600
SENS -V5264 EARMOLD 4 4 3.566667 $64.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 175 212 1319.818266 $94287.7700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 10.857143 $150.7000 $13.8800
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Subtotal (Total Children Is Unduplicated) 1220 2224 10905.224161 $611694.3400 $56.0900
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Total 2548 11267.505112 $621709.3100 $55.1800
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Number of Children (Unduplicated) With at Least One Authorization 1400