Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 07-01-20 and 09-30-20 Date of Report: 10-15-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 795 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 17 18 18.972222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 18 18.972222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 6.305555 $305.8200 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 4.511111 $106.9100 $23.7000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.166667 $8.5100 $51.0800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.277778 $6.2200 $22.4000
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 16 16 13.261111 $527.4700 $39.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.800000 $4000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.022222 $101.1100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 7.000000 $1610.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 6 6 6.285714 $314.2900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 8 8 7.285714 $364.2900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 13.295237 $664.7600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 7 8 11.678571 $583.9300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 14.142857 $353.5700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 59 60 88.626984 $4431.3500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 44 48 61.096033 $3054.8200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 7 4.355554 $108.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 23 25 44.088888 $2204.4400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 21 23 31.166667 $1558.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 56 60 93.112697 $4655.6200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 45 47 58.571427 $2928.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 11 6.211111 $155.2800 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 1.642857 $41.0700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 7 26.895237 $1344.7600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 22 23 129.704759 $6485.2500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 17 104.661904 $5233.1000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 312 379 1568.320622 $15683.2200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 5 22.004761 $1572.0200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 3 12.852381 $918.1800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 8.285714 $473.6100 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 6.133333 $438.1600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 16.476190 $1177.0600 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 2 23.000000 $1643.1200 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 7.142857 $264.2900 $37.0000
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Subtotal (Total Children Is Unduplicated) 470 761 2376.860291 $62363.0400 $26.2400
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Total 795 2409.093624 $62890.5100 $26.1100
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Number of Children (Unduplicated) With at Least One Authorization 484