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: 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 5177 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 1 1 0.766667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.766667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 676 695 733.242856 $17223.8800 $23.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.7000 $23.7000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 79 79 78.222222 $3993.2400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 29 29 62.325397 $3181.7100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 4.000000 $204.2000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 76 76 72.255555 $3688.6400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 32 33 31.788889 $1416.2000 $44.5500
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Subtotal (Total Children Is Unduplicated) 802 919 984.834919 $29833.6700 $30.2900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.000000 $20000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 406 435 614.900783 $30744.9900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 7.666667 $383.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.411111 $35.2800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 55 58 64.155555 $3207.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 176 187 180.742855 $9037.1400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 1.022222 $51.1100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 246 260 294.641271 $14732.0700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.277777 $31.9400 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 13.142857 $657.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1259 1430 15525.169744 $776258.8400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 50.571428 $2528.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 240 253 1998.983358 $142807.3200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 1.500000 $107.1600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 198 223 1524.511117 $87202.0700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 585 649 4118.278631 $294209.7900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 7 7 47.714286 $3408.7000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 4 35.714286 $2041.4300 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 0.642857 $36.7500 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 13.142858 $938.9200 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 19.714286 $1408.3900 $71.4400
RSPT -RSPT RESPITE 1 1 13.142857 $0.0000 $0.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 626 702 5570.962727 $397989.8100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 23.000000 $1643.1200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 7 42.000000 $2402.4100 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 2 26.714286 $1528.0600 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 6.571429 $469.4600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 11 16 115.999999 $1610.0800 $13.8800
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Subtotal (Total Children Is Unduplicated) 1971 4257 30317.295247 $1795471.6500 $59.2200
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Total 5177 31302.896833 $1825305.3300 $58.3100
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Number of Children (Unduplicated) With at Least One Authorization 1993