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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3584 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 155 164 117.922327 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 155 164 117.922327 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 56 81 62.039502 $3008.9400 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 11 12 16.971429 $472.3100 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 13 4.175341 $480.1400 $114.9900
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.122222 $6.2400 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 73 90 46.195308 $2358.2900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.322222 $67.5000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 113 156 85.253023 $4352.2300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 117 146 83.510965 $4263.2600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.122222 $6.2400 $51.0400
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.616667 $27.4700 $44.5500
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Subtotal (Total Children Is Unduplicated) 303 504 300.328901 $15042.6200 $50.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 54 66 48.891784 $244460.5000 $5000.0300
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 345 378 581.740466 $29086.9800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.633333 $40.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 245 323 479.894434 $23994.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 159 215 315.678564 $15783.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 424 578 735.338070 $36766.7800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 642 874 5445.280144 $272264.1100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 11.409524 $570.4800 $50.0000
INTR -T1013 INTERPRETER 4 5 25.619048 $1280.9600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 82 100 617.967461 $44147.6000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 121 180 1060.312700 $75748.7500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 1.533333 $109.5400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 2.266667 $129.5600 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 11 14 4.673971 $1065.6000 $227.9900
SENS -V5264 EARMOLD 11 14 4.673971 $84.1300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 122 161 1080.274601 $77174.8600 $71.4400
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Subtotal (Total Children Is Unduplicated) 926 2916 10418.188071 $822939.2300 $78.9900
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Total 3584 10836.439299 $837981.8500 $77.3300
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Number of Children (Unduplicated) With at Least One Authorization 1061