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: 07-01-21 and 09-30-21 Date of Report: 10-13-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2008 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 8 8 7.466668 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.833333 $67.8300 $37.0000
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Subtotal (Total Children Is Unduplicated) 9 9 9.300001 $67.8300 $7.2900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 13 14 13.027778 $631.8500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 5 5.000000 $282.4500 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.511111 $35.5000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 11 11 3.683333 $51.0900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 99 102 77.793648 $1843.7100 $23.7000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.250000 $21.2100 $84.8400
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 3.361111 $151.2500 $45.0000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 2.000000 $102.1000 $51.0500
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Subtotal (Total Children Is Unduplicated) 132 140 106.626981 $3119.1500 $29.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 14 15.693651 $78468.0000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 30.428571 $1521.4300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.388889 $27.8500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 23 24 15.566666 $3580.3200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 10 13 11.500000 $575.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 7 8 6.222222 $311.1100 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 12.027778 $601.3900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 13 14 47.384923 $2369.2400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.844444 $21.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 40 42 63.277772 $3163.8600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 74 84 103.997617 $5199.8600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 10 10 13.677779 $341.9500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 10 10 13.777776 $688.8800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 27 30 67.211108 $3360.5400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 30 32 46.717457 $2335.8600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 46 49 66.726983 $3336.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 11 11 10.766666 $269.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 164 185 1218.896817 $60944.9000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 507 613 3728.285683 $186414.4300 $50.0000
INTR -T1013 INTERPRETER 1 1 6.142857 $307.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 158 212 1036.123007 $10361.2300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 34 36 194.285710 $13879.7600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 20 24 144.295237 $10308.4500 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 20 27 98.695241 $7050.8100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 76 88 426.497614 $30469.0200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 16 21 103.722221 $7409.9100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 9 10 33.161905 $2369.1000 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 14 15 71.328570 $5095.7100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 47 50 200.266666 $14307.0500 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.722222 $329.3200 $455.9900
SENS -V5264 EARMOLD 4 4 6.511110 $117.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 34 42 240.492062 $17180.7900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 29 31 222.804761 $15917.2100 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 19 27 161.563490 $11542.0900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 96 110 671.890476 $47999.8900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 2.716667 $37.7100 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 6.733333 $93.4600 $13.8800
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Subtotal (Total Children Is Unduplicated) 922 1859 9103.345951 $548382.0700 $60.2400
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Total 2008 9219.272933 $551569.0500 $59.8300
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Number of Children (Unduplicated) With at Least One Authorization 928