Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 5732 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 10 10 11.098410 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 29 29 21.511107 $795.9000 $37.0000
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Subtotal (Total Children Is Unduplicated) 37 39 32.609517 $795.9000 $24.4100
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $9.7900 $9.7900
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $89.5200 $44.7600
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 6 6 5.533333 $282.5900 $51.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 13 12.344444 $555.5000 $45.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 10 6.194445 $316.2300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 108 115 109.085708 $5568.8100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 9 6.016666 $307.1500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 37 41 30.848410 $1574.8000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 97 108 111.861900 $5710.5400 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.244444 $12.4800 $51.0400
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 41 47 34.377776 $1531.5200 $44.5500
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Subtotal (Total Children Is Unduplicated) 200 355 321.507126 $16065.6800 $49.9700
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $690.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4 8 2.944446 $147.2300 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 1 0.677778 $33.8900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 706 846 1232.846802 $61642.0900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.522222 $13.0600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 95 108 198.714290 $9935.7100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 882 1029 1222.156305 $61107.4900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.500000 $12.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 125 144 1297.541265 $32438.6000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1219 1472 13134.307899 $656716.1900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 36.999999 $1850.0100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1141 1303 12215.684879 $122157.0000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 133 144 847.142881 $60519.8000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 15 16 111.357143 $6369.6400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 49 56 320.567469 $22901.3000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 14.642857 $1046.0900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 14 17 101.855161 $5822.0300 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 150 170 1026.285736 $73317.7400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 8 31.500002 $1801.7900 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 5.285714 $302.3400 $57.2000
SPL -92508HA GROUP SPL SESSION PER CHILD 3 3 21.071428 $292.4700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1331 5338 31825.604276 $1119116.9300 $35.1600
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Total 5732 32179.720919 $1135978.5000 $35.3000
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Number of Children (Unduplicated) With at Least One Authorization 1360