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 1716 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 103 114 84.754759 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 103 114 84.754759 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 34 51 49.003967 $2376.6900 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 0.241096 $27.7300 $115.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 1.859512 $94.9300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 24 13.155554 $671.5800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 30 18.788094 $959.1200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.022222 $45.5400 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 70 113 84.070445 $4175.5900 $49.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 11 8.169940 $40850.0000 $5000.0400
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 271 425 2281.069838 $114053.5800 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 32.585714 $2327.9300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 14 24 125.350796 $8955.0500 $71.4400
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.076712 $17.4900 $227.9600
SENS -V5264 EARMOLD 1 1 0.076712 $1.3800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 25 34 140.117461 $10010.0000 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 716 1489 3890.684465 $241377.2500 $62.0400
-------------------------------------------------------------------------------------------------------------------------------------
Total 1716 4059.509669 $245552.8400 $60.4900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 812