Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 5403 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 97 112 168.963486 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 97 112 168.963486 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 13 13.788888 $1596.8800 $115.8100
EXIT -EXIT EXIT ASSESSMENT 6 6 17.123810 $856.1900 $50.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 2 1.000000 $51.8500 $51.8500
MED -99204 OUTPATIENT VISIT, NEW, 45 MINS 1 1 0.888889 $99.4900 $111.9200
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 39 59 79.311110 $11280.4000 $142.2300
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.533333 $8.0600 $15.1100
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Subtotal (Total Children Is Unduplicated) 49 82 112.646030 $13892.8700 $123.3300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 15 15 17.844442 $892.2100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 5 5.000000 $1158.1000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 252 266 142.780163 $7139.0900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 33 33 16.689884 $834.5100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 137 145 88.177396 $2204.4400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 28 34 59.660120 $2983.0100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 3 3 3.916667 $195.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 30 40 54.009658 $1350.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 20 40.091668 $2004.5900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 2.250000 $112.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 21 25 35.126339 $878.1600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 9 11 21.266667 $1063.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 7 8.933333 $223.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 11 12.100000 $605.0000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.966667 $48.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 14 17.250001 $431.2500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 42 55 1832.285721 $45807.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 41 54 1818.000006 $45449.9900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 7 13.890476 $694.5300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1221 1642 12520.352354 $626018.1900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 39 54 328.857145 $16442.8600 $50.0000
INTR -T1013 INTERPRETER 41 47 422.107142 $21105.3500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1391 2002 15232.863464 $152328.7600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 90 122 621.506744 $44723.6300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 12 15 61.447620 $4421.7700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 21 32 196.997618 $11347.0700 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 6 7 45.428571 $2616.6800 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 95 130 732.365284 $52700.9600 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 11 14 70.642858 $5083.4500 $71.9600
PHY -97110HM PT SESSION BY PT ASST 25 31 170.123810 $9792.3200 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 6 7 47.071430 $2709.4300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 1.000000 $71.9600 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 8 9 9.766666 $2242.5100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 8 8.000000 $3673.7600 $459.2200
SENS -V5264 EARMOLD 35 47 66.533333 $1206.2500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 165 237 1462.861908 $105267.4800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 41 51 293.214289 $21099.6800 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.350000 $20.1600 $57.6000
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 26.428571 $368.9400 $13.9600
TRAV -TRAVS Travel by mile 2 2 19.276190 $8.5800 $0.4400
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Subtotal (Total Children Is Unduplicated) 1602 5209 36528.434205 $1202325.4000 $32.9100
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Total 5403 36810.043721 $1216218.2700 $33.0400
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Number of Children (Unduplicated) With at Least One Authorization 1685