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 2153 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2 2 1.344444 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 51 52 61.285714 $1440.2100 $23.5000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 0.877778 $44.8100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 18 19 30.203175 $1541.8700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.388889 $19.8500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 3.511111 $179.2400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $153.1500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 24 26 23.877778 $1218.9600 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 92 112 126.144445 $4751.2600 $37.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $460.0000 $230.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 398 470 604.337302 $30216.8700 $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 281 316 378.322223 $18916.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.900000 $47.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 485 651 6696.469821 $334823.5900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 86 103 789.678572 $56414.6700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 18.142858 $1296.1200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 29.071428 $1662.8900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 73 89 630.629367 $45052.1600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 44.714286 $2555.8700 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 177 211 1455.944442 $104012.7500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 26.285714 $1877.8500 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 4 4 27.000001 $374.7600 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 888 2039 10922.047601 $613538.7200 $56.1700
-------------------------------------------------------------------------------------------------------------------------------------
Total 2153 11049.536490 $618289.9800 $55.9600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 892