Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2629 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 136 146 102.883320 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 136 146 102.883320 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 42 49 37.729298 $1829.8600 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 3.000000 $86.7600 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 1.052055 $121.8400 $115.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 50 58 30.715219 $1579.0600 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 0.864307 $44.4300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 58 74 39.630953 $2037.4300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 44 59 28.049997 $1442.0400 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.133333 $6.8500 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 134 192 104.918963 $5393.8900 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.511111 $22.9300 $44.8600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 273 446 246.605236 $12565.0900 $50.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 39 45 37.576788 $187883.5000 $4999.9900
CONIF -CONIF CONSULT, ITDS FACE TO FACE 33 39 44.366667 $2218.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 143 168 244.444436 $12222.1800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 91 111 138.577773 $6928.8700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 200 251 361.494446 $18074.7400 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 15.247619 $762.3800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 677 980 5155.436490 $257771.9200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 55 65 462.592063 $33288.1600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 101 153 774.304762 $55718.9700 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 5 6 2.459818 $564.8200 $229.6200
SENS -V5264 EARMOLD 4 5 0.871233 $15.8000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 136 212 872.206352 $62763.9200 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 940 2037 8109.578447 $638213.5900 $78.7000
-------------------------------------------------------------------------------------------------------------------------------------
Total 2629 8459.067003 $650778.6800 $76.9300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1056