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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2612 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 3 4 1.322222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 3 4 1.322222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 496 512 548.422222 $12882.4400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.0000 $115.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 9 9.000000 $459.4500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.122222 $57.2900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 26.285714 $1341.8900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 11 11 17.450793 $854.0400 $48.9400
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Subtotal (Total Children Is Unduplicated) 517 537 604.280951 $15723.9700 $26.0200
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $690.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 412 477 474.478548 $23723.8200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 30 35 23.366666 $1168.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 128 139 217.977772 $10898.8700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 200 221 155.887291 $7794.3200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 560 693 6819.550761 $340977.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 17.142857 $171.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 41 48 259.481753 $18537.3400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 62 71 409.928577 $23447.9000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 154 179 1056.897628 $75504.7500 $71.4400
SENS -V5264 EARMOLD 5 5 5.000000 $90.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 162 184 1175.173419 $83954.4100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 15 15 145.923810 $2025.4200 $13.8800
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Subtotal (Total Children Is Unduplicated) 1139 2071 10763.809082 $588984.3000 $54.7200
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Total 2612 11369.412255 $604708.2700 $53.1900
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Number of Children (Unduplicated) With at Least One Authorization 1486