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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2968 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 126 138 83.223281 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 126 138 83.223281 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 51 68 55.391628 $2686.4900 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 10 11 17.033334 $474.0400 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 11 3.504108 $402.9700 $115.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.505556 $25.8100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 72 88 49.700242 $2537.2100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 3 3.000000 $153.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 99 129 68.793643 $3511.9800 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.277778 $14.1800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 120 141 76.984868 $3930.1400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.655556 $29.2100 $44.5500
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Subtotal (Total Children Is Unduplicated) 297 457 277.846713 $13867.2800 $49.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 48 54 40.707611 $203538.5000 $5000.0100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $230.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 130 137 133.977782 $6698.9100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 4.188889 $209.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 218 279 451.003956 $22550.1400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 5 6 8.922221 $446.1100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 140 185 296.930950 $14846.5400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 383 467 632.154746 $31607.6700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 9 11 9.499999 $475.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 641 780 5097.554764 $254877.8100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 18 19 140.428571 $7021.4300 $50.0000
INTR -T1013 INTERPRETER 3 4 25.133333 $1256.6700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 73 93 636.842855 $45496.0900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 104 143 898.166667 $64165.0500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 6.066667 $433.4100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 2 3 11.142857 $796.0500 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 11 12 3.695889 $842.6700 $228.0000
SENS -V5264 EARMOLD 11 12 4.035615 $72.6400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 125 162 1045.926983 $74721.0300 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 5.666666 $78.6500 $13.8800
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Subtotal (Total Children Is Unduplicated) 921 2373 9453.047021 $730363.7700 $77.2600
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Total 2968 9814.117015 $744231.0500 $75.8300
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Number of Children (Unduplicated) With at Least One Authorization 1035