Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 5792 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 93 102 115.665878 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 93 102 115.665878 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 9 14.000001 $1610.0100 $115.0000
EXIT -EXIT EXIT ASSESSMENT 113 114 224.532681 $11226.6400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.855556 $12.8300 $15.0000
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Subtotal (Total Children Is Unduplicated) 123 124 239.388238 $12849.4800 $53.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 18 21 30.088889 $1504.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 27 38 45.733336 $2286.6800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 6.400000 $1472.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 192 203 54.765875 $2738.4900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 10 2.534725 $63.3800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 25 27 48.723807 $2436.1800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 23 26 40.666667 $1016.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 16 17 27.940475 $1397.0200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 12 16 22.990475 $574.7600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 10 20.878572 $1043.9300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.100000 $2.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 20 22 39.948808 $1997.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 12 9.366668 $234.1700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 132 167 5246.428591 $131160.6800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1248 1579 12457.252300 $622863.4500 $50.0000
INTR -T1013 INTERPRETER 29 33 316.933332 $15846.6600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1584 2288 17795.238781 $177952.6000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 184 242 958.714295 $68490.5100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 38 47 254.983334 $14585.0600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 173 238 1038.119057 $74163.2400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 13 62.914287 $3596.1800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 3 1.216439 $79.0700 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 8 8 9.377778 $2138.1400 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 7 8.966667 $4088.8200 $456.0000
SENS -V5264 EARMOLD 34 42 45.700001 $822.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 374 483 2170.852409 $155085.6400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 4 5.500000 $76.3400 $13.8800
TRAV -TRAVS Travel by mile 1 1 7.857143 $3.5000 $0.4400
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Subtotal (Total Children Is Unduplicated) 1810 5566 40732.192711 $1297720.1000 $31.8600
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Total 5792 41087.246827 $1310569.5800 $31.9000
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Number of Children (Unduplicated) With at Least One Authorization 1874