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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4202 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 185 209 152.886681 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 185 209 152.886681 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 66 94 67.436454 $3270.6800 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 11 11 21.714286 $604.3100 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 15 4.093151 $470.7000 $115.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 85 100 53.130977 $2712.3500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 125 165 106.989929 $5461.8100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 119 147 81.588205 $4165.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.561111 $28.6400 $51.0500
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Subtotal (Total Children Is Unduplicated) 331 534 335.514113 $16713.5800 $49.8100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 64 81 60.585994 $302929.5000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.087671 $250.1700 $230.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 526 673 1261.726962 $63086.2500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 279 364 565.582535 $28279.1100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 200 272 408.953186 $20447.7200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 524 693 959.211107 $47960.5300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 666 875 5635.701542 $281785.3100 $50.0000
INTR -T1013 INTERPRETER 3 4 29.152381 $1457.6200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 90 111 735.449995 $52540.5100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 133 191 1194.709516 $85350.1200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 9.600000 $548.7400 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 17 18 4.712329 $1074.3800 $227.9900
SENS -V5264 EARMOLD 16 17 4.493151 $80.8700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 124 156 963.339674 $68821.0900 $71.4400
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Subtotal (Total Children Is Unduplicated) 967 3459 11834.306043 $954611.9000 $80.6600
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Total 4202 12322.706837 $971325.4700 $78.8200
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Number of Children (Unduplicated) With at Least One Authorization 1127