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: 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 1762 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 6 5.277777 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 6 5.277777 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 2 2 2.000000 $100.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 2 2.000000 $102.1000 $51.0500
SCREEN-T1023 SCREENING 4 4 4.000000 $200.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 5.142857 $270.3600 $52.5700
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Subtotal (Total Children Is Unduplicated) 13 16 20.142857 $1023.3100 $50.8000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 4 6.033333 $301.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 3.000000 $150.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 461 644 1565.911906 $78295.6100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 0.750000 $18.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 271 376 1055.733331 $52786.6600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 147 199 617.680951 $30884.0400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 368 452 1120.311903 $56015.5900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 2 3.000000 $150.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 9.733333 $243.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 19 22 127.454763 $6372.7300 $50.0000
INTR -T1013 INTERPRETER 4 4 10.323809 $516.1900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 5 15.204763 $1086.2300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 2.714286 $155.2600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 6 7 34.457142 $2461.6200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 17.123810 $978.8000 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 13 14 86.714287 $6194.8600 $71.4400
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Subtotal (Total Children Is Unduplicated) 565 1740 4676.147617 $236611.3200 $50.6000
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Total 1762 4701.568251 $237634.6300 $50.5400
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Number of Children (Unduplicated) With at Least One Authorization 571