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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1621 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 138 148 92.338880 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 138 148 92.338880 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 44 61 51.816069 $2513.0900 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.022222 $117.5500 $115.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 13 14 5.077243 $259.1900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 18 10.516666 $536.8700 $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 23 28 12.855555 $656.2700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.677777 $30.1900 $44.5400
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Subtotal (Total Children Is Unduplicated) 85 125 82.965532 $4164.2100 $50.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 12 10.377778 $51889.0000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 51 55 92.314284 $4615.7100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 202 256 375.665877 $18783.3100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 3 1.500000 $75.0000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 133 168 253.366664 $12668.3200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 0.744444 $37.2200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 318 423 561.136503 $28056.8100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 8 11 10.077776 $503.8800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 242 339 2027.157126 $101357.9500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 3 11.333333 $566.6700 $50.0000
INTR -T1013 INTERPRETER 1 1 55.200000 $2760.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 18 105.104762 $7508.7000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 12 21 78.847619 $5632.8700 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.022222 $233.0600 $228.0000
SENS -V5264 EARMOLD 1 1 1.022222 $18.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 26 34 221.457140 $15820.9200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 3.000000 $41.6400 $13.8800
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Subtotal (Total Children Is Unduplicated) 663 1348 3809.327750 $250569.4400 $65.7800
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Total 1621 3984.632162 $254733.6500 $63.9300
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Number of Children (Unduplicated) With at Least One Authorization 798