Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 4871 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 89 106 216.103183 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 89 106 216.103183 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 5 2.283333 $53.6600 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 5 2.283333 $53.6600 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 5 2.283333 $33.2900 $14.5800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 5 2.283333 $22.3500 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 5 2.283333 $65.5800 $28.7200
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.705555 $144.6900 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 5 2.283333 $31.3000 $13.7100
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.261111 $11.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.261111 $30.0300 $115.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 3.138889 $156.9500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 13 41.838095 $2091.9100 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 18 51 61.904759 $2746.2100 $44.3600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 5.426190 $27131.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 182 287 412.500078 $20625.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 191 283 321.256843 $8031.4200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 208 232 251.497618 $12574.8800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 13 14 10.061111 $251.5300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 157 166 158.807144 $7940.3600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 3.022222 $75.5600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 86 95 110.878571 $5543.9200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 0.511111 $12.7800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 184 200 202.158733 $10107.9500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 12 8.783333 $219.5800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1358 1822 14950.844421 $747543.0700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 39.428571 $1971.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 257 343 2803.580943 $200288.1000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 277 390 3114.366659 $222490.6000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 6 7 86.619046 $6188.0800 $71.4400
SENS -V5264 EARMOLD 3 4 2.022222 $36.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 620 841 7074.060293 $505371.4400 $71.4400
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Subtotal (Total Children Is Unduplicated) 1883 4714 29568.967966 $1777342.0200 $60.1100
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Total 4871 29846.975908 $1780088.2300 $59.6400
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Number of Children (Unduplicated) With at Least One Authorization 1948