Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 1697 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 4 4 3.477778 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 4 4 3.477778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $27.7400 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 2.000000 $18.1600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 2.000000 $44.8000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.298630 $13.4400 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.345206 $39.7100 $115.0300
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.000000 $100.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 7 10 10.000000 $510.5000 $51.0500
SCREEN-T1023 SCREENING 4 4 4.000000 $200.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 8 8.000000 $408.4000 $51.0500
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Subtotal (Total Children Is Unduplicated) 20 37 33.643836 $1491.6300 $44.3400
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 3.066667 $153.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 6 10.866668 $543.3400 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 6 6.500000 $325.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 408 551 1726.811892 $86340.5400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.000000 $25.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 261 343 1139.076182 $56953.7700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 2 3.066667 $153.3400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 135 171 518.266670 $25913.3500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 380 471 1404.414286 $70220.7200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.800000 $70.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 30 37 191.985711 $9599.2900 $50.0000
INTR -T1013 INTERPRETER 8 11 96.847619 $4842.3900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 14 43.795237 $3128.7300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 6 6 54.276190 $3104.6000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 5.571429 $318.6800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 4 6 36.790476 $2628.3000 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 4.000000 $912.0000 $228.0000
SENS -V5264 EARMOLD 2 2 2.422222 $43.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 20 20 163.895236 $11708.6700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.000000 $142.8800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 34.571429 $479.8500 $13.8800
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Subtotal (Total Children Is Unduplicated) 508 1656 5452.024581 $277607.3700 $50.9200
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Total 1697 5489.146195 $279099.0000 $50.8500
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Number of Children (Unduplicated) With at Least One Authorization 512