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 1725 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 125 137 83.067725 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 125 137 83.067725 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 44 58 47.947184 $2325.4400 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 3.266667 $90.9100 $27.8300
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 1.208219 $138.9500 $115.0100
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 11 3.566667 $182.0800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 19 24 14.327780 $731.4400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 18 21 10.400002 $530.9300 $51.0500
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Subtotal (Total Children Is Unduplicated) 89 122 81.716519 $4050.8100 $49.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 7.383333 $36916.5000 $4999.9800
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 231 288 2036.889682 $101844.4800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 4 31.761904 $1588.1000 $50.0000
INTR -T1013 INTERPRETER 3 4 25.133333 $1256.6700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 12 76.238095 $5446.4600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 20 26 119.604762 $8544.5700 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.400000 $100.0200 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 1.208219 $275.4900 $228.0200
SENS -V5264 EARMOLD 4 4 1.208219 $21.7500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 22 28 184.628570 $13189.8700 $71.4400
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Subtotal (Total Children Is Unduplicated) 679 1466 4022.134660 $246017.6900 $61.1700
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Total 1725 4186.918904 $250068.5000 $59.7300
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Number of Children (Unduplicated) With at Least One Authorization 803