Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 01-01-21 and 03-31-21 Date of Report: 05-04-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 480 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 19 23 27.844444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 23 27.844444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 4 3.038889 $147.3900 $48.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 3.000000 $71.1000 $23.7000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.333333 $17.0200 $51.0600
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.238889 $5.3500 $22.4000
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Subtotal (Total Children Is Unduplicated) 9 9 6.611111 $240.8600 $36.4300
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.311111 $301.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 8 10 6.505556 $325.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 15 16 11.276190 $563.8100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 3.583333 $179.1700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 16 16 33.548414 $1677.4300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 5.133333 $128.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 37 38 61.945236 $3097.2600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 74 84 121.061904 $6053.1000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 12 13 23.688889 $592.2200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 10 8.638889 $431.9500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 25 29 59.003967 $2950.2000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 12.000000 $300.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 37 37 47.393655 $2369.7000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 37 42 49.994448 $2499.7400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 17 17 13.316665 $332.9100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 20 24 130.923809 $6546.1900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 16 17 106.261905 $5313.0900 $50.0000
INTR -T1013 INTERPRETER 1 1 0.700000 $35.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 60 73 284.387300 $2843.8700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1 1 6.714286 $479.6700 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 18.980953 $1356.0000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2 2 8.285714 $591.9400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 7.285714 $520.4900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 3.866667 $276.2400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 19.714286 $1408.3800 $71.4400
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Subtotal (Total Children Is Unduplicated) 286 448 1045.522224 $41173.5000 $39.3800
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Total 480 1079.977779 $41414.3600 $38.3500
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Number of Children (Unduplicated) With at Least One Authorization 304