Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 1761 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 6 7 4.822221 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6 7 4.822221 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 4 4 4.000000 $200.0000 $50.0000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 4 4.000000 $204.2000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 12 13 13.000000 $657.3500 $50.5700
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 5 12.000001 $600.0100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 1.866667 $93.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 466 614 1683.402373 $84170.0800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 297 406 1199.199993 $59959.9700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 6.133333 $153.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 139 180 510.538094 $25526.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 370 459 1214.038098 $60701.9200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 5 8.300000 $207.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 18 21 144.609524 $7230.4800 $50.0000
INTR -T1013 INTERPRETER 11 11 112.142856 $5607.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 6 20.442857 $1460.4300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 3 16.857144 $964.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 6 6 25.971429 $1855.4000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 4.571429 $261.3000 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 17 19 119.709521 $8552.0400 $71.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 579 1741 5084.849986 $257953.3800 $50.7300
-------------------------------------------------------------------------------------------------------------------------------------
Total 1761 5102.672207 $258610.7300 $50.6800
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 587