Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 5249 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 114 129 172.644443 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 114 129 172.644443 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 9 9.866667 $1134.6700 $115.0000
EXIT -EXIT EXIT ASSESSMENT 29 29 58.000000 $2900.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 5 2.543075 $38.1500 $15.0000
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Subtotal (Total Children Is Unduplicated) 40 43 70.409742 $4072.8200 $57.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 10 11.744444 $587.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 48 67 93.355558 $4667.7900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 12 12 12.000000 $2760.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 117 124 36.184621 $1809.3600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 8 8 3.316668 $165.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 102 105 40.591999 $1014.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 19 25 39.033333 $1951.6700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 1.533333 $76.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 24 25 40.016666 $1000.4200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 11 14 25.600000 $1280.0000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 4.200000 $210.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 12 13 16.166665 $404.1600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 7 7 12.916667 $645.8400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 2 1.533333 $76.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 14 16 22.849999 $1142.5000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 3 3.066666 $153.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 14 14 22.066666 $551.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 79 99 3025.714290 $75642.8300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1234 1623 12538.257117 $626913.6600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 41 51 362.499998 $18125.0300 $50.0000
INTR -T1013 INTERPRETER 26 30 390.785711 $19539.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1451 2055 16275.186479 $162752.0700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 85 105 549.973817 $39290.0900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 13 17 66.923809 $4781.0400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 28 35 177.471432 $10151.3500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 6 9 28.571429 $1634.2800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 96 125 667.588096 $47692.4900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 12 21 55.216669 $3944.6800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 23 29 141.500004 $8088.1200 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 4 16.061905 $918.1000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 8 8 7.108371 $462.0500 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 2 2.000000 $228.0000 $114.0000
SENS -V5060 BEHIND EAR HEARING AID 6 7 7.866667 $1793.6100 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 11 11 11.000000 $5016.0000 $456.0000
SENS -V5264 EARMOLD 41 57 77.533333 $1395.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 230 303 1513.069074 $108093.5300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 33 37 174.316671 $12453.1600 $71.4400
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Subtotal (Total Children Is Unduplicated) 1643 5077 36475.821490 $1172412.9100 $32.1400
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Total 5249 36718.875675 $1176485.7200 $32.0400
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Number of Children (Unduplicated) With at Least One Authorization 1741