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: 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 2007 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 20 21 18.238888 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 20 21 18.238888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 18 24.910317 $1208.1400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $23.5000 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.327778 $4.7800 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 132 138 84.023812 $1974.5700 $23.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 5.316667 $239.2500 $45.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 4.600000 $241.8200 $52.5700
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 153 169 122.178574 $3803.2700 $31.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 14 10.672222 $53361.0000 $4999.9900
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.066667 $4.5900 $68.8900
AUDE -V5160 DISPENSING FEE BINAURAL 21 23 18.800000 $4324.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 9 10 7.750000 $387.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 10 12 13.116667 $655.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 3.000000 $75.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 5 10.466667 $523.3400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 9 9 7.384921 $369.2500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 37 37 47.766668 $2388.3400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 61 66 81.192066 $4059.6100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 12 12 10.950001 $273.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 26 29 66.897618 $3344.8800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 26 29 57.568254 $2878.4200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.450000 $11.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 22 24 25.133334 $1256.6700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 28 30 49.879366 $2493.9700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 5.500000 $137.5000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 8.142856 $407.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 178 193 1290.220638 $64511.0100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 475 568 3328.776984 $166438.7300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 223 304 1378.688090 $13786.8800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 24 149.523809 $10681.9700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 13 16 49.038094 $3503.2700 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 26 30 139.342858 $9954.6600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 47 60 288.540476 $20613.3300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 20 24 166.376191 $11885.9200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 9 9 36.666666 $2619.4800 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 22 27 117.533333 $8396.5900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 37 41 226.090477 $16151.8800 $71.4400
SENS -V5264 EARMOLD 2 2 4.000000 $72.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 39 43 225.771428 $16129.0900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 23 28 149.323808 $10667.6800 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 29 33 195.871429 $13993.0500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 82 97 620.438891 $44324.1300 $71.4400
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.000000 $83.2800 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 866 1817 8798.940479 $490814.9900 $55.7800
-------------------------------------------------------------------------------------------------------------------------------------
Total 2007 8939.357941 $494618.2600 $55.3300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 884