Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 2035 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 15 16 34.622224 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 16 34.622224 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 12 12 11.494444 $557.4800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $111.4200 $55.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.500000 $35.2500 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 1.661110 $24.2200 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 111 115 95.474598 $2243.6400 $23.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 5.000000 $225.0000 $45.0000
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Subtotal (Total Children Is Unduplicated) 135 142 117.130152 $3197.0100 $27.2900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 9 8.005555 $40027.5000 $4999.9700
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.000000 $100.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.511111 $35.1900 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 26 26 19.738888 $4539.9200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 6 5.750000 $287.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 11 12 34.240476 $1712.0300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 6 8.666666 $433.3300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 12 13 35.730951 $1786.5400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 35 38 48.900000 $2445.0000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 62 68 102.575395 $5128.7500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 9 9 6.038888 $150.9700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 18 20 36.196825 $1809.8400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 33 38 73.033333 $3651.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.450000 $36.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 25 26 29.561109 $1478.0500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 31 33 48.032539 $2401.6200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 10 7.022222 $175.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 175 202 1480.656350 $74032.8600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 533 642 4122.575372 $206128.8700 $50.0000
INTR -T1013 INTERPRETER 1 1 2.857143 $142.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 182 252 1108.031740 $11080.3300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 23 28 136.138095 $9725.7100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 22 24 117.676190 $8406.7900 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 25 29 105.285714 $7521.6100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 69 76 550.979366 $39362.0000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 16 20 131.014285 $9359.6800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 10 12 27.300002 $1950.3300 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 16 18 50.595236 $3614.5100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 35 40 205.423805 $14675.4700 $71.4400
SENS -V5264 EARMOLD 3 5 6.177777 $111.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 36 46 253.379361 $18101.4500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 27 32 195.714284 $13981.8400 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 25 30 172.426982 $12318.1900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 87 99 698.625394 $49909.8200 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 0.666667 $9.2500 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 2 6.133333 $85.1300 $13.8800
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Subtotal (Total Children Is Unduplicated) 952 1877 9839.111054 $546717.5600 $55.5700
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Total 2035 9990.863430 $549914.5700 $55.0400
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Number of Children (Unduplicated) With at Least One Authorization 962