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: 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 6933 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 2 2 1.188889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.188889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 925 970 1009.666667 $23717.0700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $27.7400 $13.8700
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 91 95 93.911111 $4794.1600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 28 28 35.385714 $1806.4400 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $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 16 16 15.388889 $785.6000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 11 12 12.000000 $612.6000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 125 132 167.266667 $7451.7300 $44.5500
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Subtotal (Total Children Is Unduplicated) 1075 1259 1339.619048 $39398.5000 $29.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 5.000000 $25000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $690.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 470 546 617.328542 $30866.2800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 55 63 59.116666 $2955.8300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 200 223 441.847603 $22092.3000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 263 308 298.311101 $14915.5100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 3.844445 $96.1100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1615 2046 20464.790478 $1023239.5500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 8 89.319047 $4465.9500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 133 170 1063.387302 $75968.3900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 419 511 3696.614283 $211446.3900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 716 885 5251.906347 $375196.2700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 0.571429 $40.8200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 10 13 126.285715 $7218.4900 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 1.285714 $73.4900 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 9.285714 $663.3700 $71.4400
SENS -V5264 EARMOLD 8 9 9.000000 $162.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 668 811 6131.506737 $438034.9000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 4 34.000000 $1944.8000 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.285714 $359.5400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 13.000000 $928.7200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 40 57 326.496575 $4531.7800 $13.8800
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Subtotal (Total Children Is Unduplicated) 2405 5672 38652.183412 $2240890.4900 $57.9800
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Total 6933 39992.991349 $2280288.9900 $57.0200
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Number of Children (Unduplicated) With at Least One Authorization 2430