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: 04-01-22 and 06-30-22 Date of Report: 08-08-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2493 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.250000 $9.2500 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 33 37 35.469841 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 34 38 35.719841 $9.2500 $0.2600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 15 11.690477 $566.9900 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 12 12 10.500000 $246.7500 $23.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 165 173 106.882559 $2511.7900 $23.5000
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.505556 $112.7500 $45.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 9.000000 $459.4500 $51.0500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 14.704763 $773.0300 $52.5700
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Subtotal (Total Children Is Unduplicated) 194 207 155.283355 $4670.7600 $30.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 13 9.094444 $45472.0000 $4999.9800
AUDE -V5160 DISPENSING FEE BINAURAL 13 13 11.933335 $2744.7100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 6 6 4.783333 $239.1700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 4 4.300000 $215.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 4.500000 $112.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4 4 5.572221 $278.6100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 3 4 3.116666 $155.8300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 56 68 85.441270 $4272.0700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 39 40 45.077777 $2253.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 11 12 19.738888 $493.4700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 39 46 72.030954 $3601.5600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 22 23 43.450794 $2172.5400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 36 41 42.488093 $2124.3900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 21 21 25.510316 $1275.5100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 5.883333 $147.0800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 25 27 744.676189 $37233.8100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 373 417 2413.536497 $120676.8800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 337 375 2236.723036 $111836.2100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 508 714 3603.119813 $36031.2100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 33 38 220.262698 $15735.5900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 7 7 24.347620 $1739.4000 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 32 36 230.757142 $16485.3000 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 25 27 125.738096 $8982.7200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 28 35 248.830158 $17776.4300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 4 4 26.555556 $1897.1300 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 31 38 208.919047 $14925.1900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 24 25 103.438098 $7389.6200 $71.4400
SENS -V5264 EARMOLD 3 5 9.111111 $164.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 62 76 413.917457 $29570.2700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 13 15 63.966668 $4569.7700 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 38 41 261.523810 $18683.2800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 55 58 377.752387 $26986.6500 $71.4400
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.000000 $69.4000 $13.8800
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Subtotal (Total Children Is Unduplicated) 915 2248 11703.096807 $536361.1500 $45.8300
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Total 2493 11894.100003 $541041.1600 $45.4900
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Number of Children (Unduplicated) With at Least One Authorization 940