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 3180 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 1 1 1.000000 $115.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 29 29 58.000000 $2900.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 2.244444 $33.6700 $15.0000
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Subtotal (Total Children Is Unduplicated) 33 33 61.244444 $3048.6700 $49.7800
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 6 8.600000 $430.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 379 496 3828.409519 $191420.6700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 16 19 135.642858 $6782.1500 $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 4 4 12.247619 $874.9700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 8.428571 $602.1400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.000000 $228.8000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 0.642857 $36.7700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 7 7 58.642857 $4189.4400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 1.214286 $86.7500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 6.928572 $396.0300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 4.911111 $319.2200 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.000000 $912.0000 $456.0000
SENS -V5264 EARMOLD 4 5 6.133333 $110.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 17 88.419051 $6316.6500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 11.142857 $796.0500 $71.4400
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Subtotal (Total Children Is Unduplicated) 1476 3018 21115.412297 $406964.3200 $19.2700
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Total 3180 21349.301184 $410012.9900 $19.2000
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Number of Children (Unduplicated) With at Least One Authorization 1581