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: 07-01-20 and 06-30-21 Date of Report: 07-15-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1538 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 37 45 93.438889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 37 45 93.438889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 12 13 10.999999 $533.5000 $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 9 9 9.472222 $224.4900 $23.7000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.011111 $51.6400 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.027778 $23.0200 $22.4000
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 25 26 25.511110 $989.1400 $38.7700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.133333 $5666.5000 $4999.8500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 3.855556 $192.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 8.322223 $1914.1300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 21 28 24.046826 $1202.3500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 46 49 42.672221 $2133.6200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 10 10 32.717460 $1635.8800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 23 25 110.929365 $5546.4800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 27.606348 $690.1600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 102 117 257.817461 $12890.8700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 126 157 383.573011 $19178.6300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 18 19 51.822221 $1295.5500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 33 35 80.033334 $4001.6700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 48 63 210.665873 $10533.3000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 17.400000 $435.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 90 105 237.884128 $11894.2000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 96 113 228.742062 $11437.1000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 27 32 40.844445 $1021.1100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 7.285714 $182.1400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 7 27.945237 $1397.2600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 38 44 529.809521 $26490.5000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 33 39 422.509523 $21125.4700 $50.0000
INTR -T1013 INTERPRETER 1 1 3.733333 $186.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 426 562 2895.906337 $28959.0800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 7 34.438095 $2460.2600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 12.142857 $867.4800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 48.276190 $3448.8400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 6 6 58.128571 $4152.7100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 8.285714 $473.6100 $57.1600
SENS -V5264 EARMOLD 1 1 2.000000 $36.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 6 32.260318 $2304.6900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 50.752380 $3625.7400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 6 88.447618 $6318.7000 $71.4400
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 7.142857 $264.2900 $37.0000
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Subtotal (Total Children Is Unduplicated) 761 1467 5990.130132 $193987.7400 $32.3800
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Total 1538 6109.080131 $194976.8800 $31.9200
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Number of Children (Unduplicated) With at Least One Authorization 788