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 2243 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 49 69 54.995056 $2667.2700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 4.700000 $130.8000 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 1.704109 $195.9600 $114.9900
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 11 3.544444 $180.9400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 25 34 18.933334 $966.5500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 16 20 10.627777 $542.5400 $51.0500
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Subtotal (Total Children Is Unduplicated) 90 142 94.504720 $4684.0700 $49.5600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 11 15 12.638737 $63194.0000 $5000.0200
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 246 331 2153.327766 $107666.4100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 1.285714 $64.2900 $50.0000
INTR -T1013 INTERPRETER 4 5 25.619048 $1280.9600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 13 69.985715 $4999.7900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 29 41 198.719049 $14196.5000 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 1.704109 $388.5100 $227.9900
SENS -V5264 EARMOLD 4 4 1.704109 $30.6700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 23 28 173.769842 $12414.1300 $71.4400
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Subtotal (Total Children Is Unduplicated) 687 1937 4753.038956 $309908.4000 $65.2000
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Total 2243 4965.466003 $314592.4700 $63.3600
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Number of Children (Unduplicated) With at Least One Authorization 836