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: 04-01-21 and 06-30-21 Date of Report: 07-15-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 602 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 10 10 14.549999 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 10 14.549999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 4 5 4.444444 $215.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 4.188889 $99.2800 $23.7000
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Subtotal (Total Children Is Unduplicated) 10 11 9.633333 $371.3200 $38.5500
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.011112 $232.5800 $230.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 9 7.505556 $375.2800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 14 14 15.538889 $776.9500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 9.705556 $485.2800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 15 15 49.627778 $2481.4000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 5.044444 $126.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 44 51 62.857144 $3142.8600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 81 89 110.433335 $5521.6800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 7 10.044444 $251.1100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 10 14.111111 $705.5600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 29 33 73.517458 $3675.8700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 32 38 54.022222 $2701.1100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 47 53 78.359525 $3917.9900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 17 20 16.733333 $418.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16 17 136.638095 $6831.9100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 14 14 82.683335 $4134.1800 $50.0000
INTR -T1013 INTERPRETER 1 1 3.033333 $151.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 131 174 538.057936 $5380.5800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 4 11.152381 $796.7300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 12.142857 $867.4800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 15.019048 $1072.9600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 3 3 35.857143 $2561.6400 $71.4400
SENS -V5264 EARMOLD 1 1 2.000000 $36.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4 4 14.807937 $1057.8900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 34.552381 $2468.4200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 15.876190 $1134.2000 $71.4400
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Subtotal (Total Children Is Unduplicated) 344 581 1412.332543 $51380.7300 $36.3800
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Total 602 1436.515875 $51752.0500 $36.0300
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Number of Children (Unduplicated) With at Least One Authorization 353