Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 4563 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 103 112 346.258729 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 103 112 346.258729 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 6.000000 $690.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 42 42 91.142857 $4557.1500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 4.277626 $64.1700 $15.0000
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Subtotal (Total Children Is Unduplicated) 50 51 101.420483 $5311.3100 $52.3700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 5 5.000000 $25000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 15 19 26.166665 $1308.3300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 31 39 65.833335 $3291.6800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 6.000000 $1380.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 92 94 25.253949 $1262.7900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 6 6 10.354764 $517.7500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 67 70 33.338592 $833.5100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 15 31.604759 $1580.2200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 3 3 5.116667 $255.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 10 12 16.616668 $415.4200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 8 19.304761 $965.2300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 1.533333 $76.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 10 15.633334 $390.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 3.599999 $180.0000 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 2 2 4.733334 $236.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.233333 $55.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 12 13 23.199998 $1159.9900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.383333 $19.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 9 12.283332 $307.0800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 88 101 3115.857152 $77896.4100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 885 1062 8601.214224 $430061.4300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 175 200 1481.471429 $74073.6400 $50.0000
INTR -T1013 INTERPRETER 35 39 295.380952 $14769.0400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1291 1791 14655.828496 $146558.5000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 106 129 641.114296 $45801.1600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 23 28 107.761905 $7698.4900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 18 21 97.264287 $5563.5100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 6 6 11.400000 $652.0800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 128 173 852.892871 $60930.5900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 19 22 99.830954 $7131.9100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 18 21 84.828572 $4848.8000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 4 4 16.435715 $939.4600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 13 14 8.926028 $580.2000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.210959 $24.0500 $114.0200
SENS -V5060 BEHIND EAR HEARING AID 5 6 6.000000 $1368.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 6 5.500000 $2508.0000 $456.0000
SENS -V5264 EARMOLD 35 44 71.088889 $1279.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 273 324 1537.626218 $109847.8700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 77 82 407.388099 $29103.8000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 6.571429 $375.8800 $57.2000
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 3.785714 $270.4500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 111.285713 $1544.6500 $13.8800
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Subtotal (Total Children Is Unduplicated) 1492 4400 32527.854058 $1063064.4900 $32.6800
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Total 4563 32975.533270 $1068375.8000 $32.4000
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Number of Children (Unduplicated) With at Least One Authorization 1561