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: 07-01-22 and 09-30-22 Date of Report: 10-19-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1379 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 26 26 31.088096 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 26 26 31.088096 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 10 11 7.227778 $350.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 11.571429 $649.1600 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 2.550000 $49.7500 $19.5100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 3.511111 $77.4900 $22.0700
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Subtotal (Total Children Is Unduplicated) 18 20 24.860318 $1126.9400 $45.3300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 7 4.522222 $22611.0000 $4999.9800
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.066667 $247.0700 $231.6300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 6 6 3.726983 $186.3500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 3 3 2.285714 $114.2900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 8 10.580157 $529.0000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 2.983333 $149.1700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 77 92 117.739684 $5886.9900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 23 24 21.244445 $1062.2300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 10.920635 $273.0200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 55 61 97.203968 $4860.1900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 7 7 23.564285 $1178.2100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 43 45 62.191264 $3109.5400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 12 12 11.850001 $592.5100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 5.966667 $149.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 28 32 451.934919 $22596.7700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 25 28 217.347617 $10867.3800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 9 76.304762 $3815.2400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 678 961 5739.599968 $57396.0400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 5 5 40.465078 $2911.8700 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 5.000000 $359.8000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 1 1 5.714286 $411.2000 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 2 12.928571 $930.3400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 12 117.914285 $8485.1300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.571429 $113.0800 $71.9600
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Subtotal (Total Children Is Unduplicated) 711 1333 7044.626940 $148835.5500 $21.1300
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Total 1379 7100.575354 $149962.4900 $21.1200
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Number of Children (Unduplicated) With at Least One Authorization 730