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 2717 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
EXIT -EXIT EXIT ASSESSMENT 42 42 91.142857 $4557.1500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.210959 $3.1700 $15.0000
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Subtotal (Total Children Is Unduplicated) 43 43 91.353816 $4560.3100 $49.9200
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.000000 $50.0000 $50.0000
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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 285 341 2730.890449 $136544.7700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 61 68 497.547618 $24877.4100 $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 7 10 48.714285 $3480.1500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 4.714286 $336.7900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 16 20 85.571430 $6113.2100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 3.000000 $214.3200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 15.785714 $902.3100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.210959 $78.7200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.210959 $24.0500 $114.0200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.500000 $228.0000 $456.0000
SENS -V5264 EARMOLD 1 1 0.500000 $9.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 21 90.214288 $6444.9000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 8 8 36.071429 $2576.9400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 80.357142 $1115.3600 $13.8800
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Subtotal (Total Children Is Unduplicated) 1319 2562 18752.688163 $352580.4500 $18.8000
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Total 2717 19190.300708 $357140.7600 $18.6100
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Number of Children (Unduplicated) With at Least One Authorization 1396