Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 6701 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 2 2 1.344444 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 1.344444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $23.5000 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 954 987 1033.320633 $24283.0300 $23.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 26.285714 $1341.8900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 20 21 16.677778 $851.4000 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 87 90 122.955556 $6276.8800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 3.788889 $193.4200 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 21 21 18.066667 $922.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 13.428571 $685.5300 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 13 13 11.655556 $595.0200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 113 126 130.457144 $6659.8400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 7 7.022222 $312.8400 $44.5500
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Subtotal (Total Children Is Unduplicated) 1104 1283 1389.658730 $42400.9100 $30.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 6.022222 $30111.0000 $4999.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 3.000000 $150.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 2.000000 $137.7200 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 20 20 26.428571 $6078.5800 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 399 471 606.470635 $30323.5400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 2 1.022222 $51.1100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 74 84 106.333337 $5316.6900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 87 92 108.196028 $5409.7800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 282 317 379.211112 $18960.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.900000 $47.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1490 1984 20182.341571 $1009117.3200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 13.142857 $657.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 529 653 5083.370650 $363156.1400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 23.357144 $1668.6300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 30 32 214.607143 $12275.5500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 630 784 5388.710364 $384969.4100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 17 17 118.642856 $6781.6400 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 3 24.571429 $1404.5000 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 727 914 6980.970637 $498720.8700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 48.071428 $3434.2200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.357143 $77.6300 $57.2000
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.000000 $285.7600 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 18 18 99.928572 $1387.0100 $13.8800
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Subtotal (Total Children Is Unduplicated) 2179 5416 39423.655921 $2380522.2900 $60.3800
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Total 6701 40814.659095 $2422923.2100 $59.3600
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Number of Children (Unduplicated) With at Least One Authorization 2200