Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 4886 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 96 101 66.313489 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 96 101 66.313489 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 5 5 2.027777 $98.3400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 3.571429 $198.9600 $55.7100
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.855556 $38.5000 $45.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 2 0.511111 $26.0900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 9 16.181746 $826.0800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 146 176 101.536501 $5183.4100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 5 1.533334 $78.2800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 109 147 73.252379 $3739.5300 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.155555 $7.9400 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 65 78 23.777773 $1213.8300 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $26.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.511111 $26.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 66 72 75.339678 $3356.3700 $44.5500
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Subtotal (Total Children Is Unduplicated) 293 505 300.276172 $14845.6100 $49.4400
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $68.8600 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.022222 $465.1100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 60 164 110.557932 $5527.8900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 2 0.088888 $4.4400 $49.9500
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.005556 $0.2800 $50.4000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 1.500000 $37.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 3 0.761111 $38.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 7 7.290477 $182.2600 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.644444 $16.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 0.505556 $25.2800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 10.780952 $269.5200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 167 218 1859.071427 $46476.8500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1320 1622 14301.061832 $715054.1600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 4 19.857142 $992.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1296 1617 14146.903895 $141469.2500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 115 149 1150.764276 $82210.7800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 4.428571 $316.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 89 99 794.209529 $45428.8200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 90 129 957.725396 $68420.0000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 3 6.999999 $500.0900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 59 67 546.500006 $31237.9400 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 2 13.142857 $751.2500 $57.1600
SENS -V5264 EARMOLD 1 1 0.511111 $9.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 94 119 845.559526 $60406.8900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 4 19.714285 $1127.6600 $57.2000
SPL -92508HA GROUP SPL SESSION PER CHILD 44 54 353.000001 $4899.6400 $13.8800
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Subtotal (Total Children Is Unduplicated) 1592 4280 35156.606991 $1206037.0700 $34.3000
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Total 4886 35523.196652 $1220882.6800 $34.3700
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Number of Children (Unduplicated) With at Least One Authorization 1667