Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 3496 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 104 115 85.776981 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 104 115 85.776981 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 40 60 56.520633 $2741.2400 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 6.066667 $174.2400 $28.7200
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 8 1.128767 $129.8000 $114.9900
OCTH -97167 OT EVAL HIGH COMPLEXITY 87 113 59.211719 $3022.7500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 100 143 66.038054 $3371.2500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 192 259 165.698021 $8458.8800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 10 8.169786 $363.9600 $44.5500
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Subtotal (Total Children Is Unduplicated) 367 597 362.833647 $18262.1300 $50.3300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 42 58 43.940639 $219703.5000 $5000.0100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 64 78 119.077780 $5953.9000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 240 299 409.599199 $20479.9200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 3 1.777778 $88.8900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 124 172 215.274603 $10763.7300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 321 433 551.019042 $27550.9300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 3.422223 $171.1200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 714 1098 5874.592050 $293729.8700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 12.190476 $609.5200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 92 131 766.328567 $54746.5900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 1.566667 $89.6200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 106 177 891.733328 $63705.4000 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 5 6 0.964383 $219.8600 $227.9800
SENS -V5264 EARMOLD 5 6 2.126027 $38.2700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 207 317 1327.833336 $94860.5500 $71.4400
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Subtotal (Total Children Is Unduplicated) 1083 2784 10224.512765 $792864.9900 $77.5500
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Total 3496 10673.123393 $811127.1200 $76.0000
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Number of Children (Unduplicated) With at Least One Authorization 1172