Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5278 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 126 132 168.135716 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 126 132 168.135716 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 7.000000 $805.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 9 9 18.000000 $900.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 5 4.246575 $63.7000 $15.0000
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Subtotal (Total Children Is Unduplicated) 19 21 29.246575 $1768.7000 $60.4800
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 6.088888 $304.4400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 51 65 115.777778 $5788.8900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 7.000000 $1610.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 131 134 41.650490 $2082.6400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 2.071429 $103.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 138 146 45.056769 $1126.4700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 18 23 25.899999 $1295.0000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 3 2.000000 $100.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 24 31 40.133334 $1003.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 12 15 25.716666 $1285.8300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.833333 $41.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 10 13 18.450000 $461.2500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 5 6.733333 $336.6700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 0.650000 $32.5000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.000000 $75.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 13 16 20.649999 $1032.5000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 3 2.150000 $107.5000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 16 18.716667 $467.9200 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 4.000000 $100.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 62 80 2187.857143 $54696.4400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 6.571428 $328.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1248 1672 12400.438103 $620021.1300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 43 49 368.228572 $18411.4100 $50.0000
INTR -T1013 INTERPRETER 57 61 361.785716 $18089.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1456 2070 15315.342873 $153153.2500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 85 114 578.209521 $41307.3200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 11 12 37.214284 $2658.5900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 22 34 146.142855 $8359.3900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 3 4 13.785713 $788.5500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 84 115 525.223807 $37521.9700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 7 10 40.571428 $2898.4300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 26 42 135.349997 $7736.6200 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 6 24.090475 $1377.0200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 4.000000 $260.0000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5060 BEHIND EAR HEARING AID 4 4 4.000000 $912.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 6 6.000000 $2736.0000 $456.0000
SENS -V5264 EARMOLD 39 49 80.100001 $1441.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 205 257 1233.123804 $88094.4200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 31 39 153.857140 $10991.5600 $71.4400
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Subtotal (Total Children Is Unduplicated) 1626 5125 34009.471545 $1089252.9100 $32.0300
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Total 5278 34206.853836 $1091021.6100 $31.8900
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Number of Children (Unduplicated) With at Least One Authorization 1720