Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 1230 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 49 52 133.238096 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 49 52 133.238096 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.511111 $9.9700 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.511111 $12.1000 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.511111 $7.5000 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.511111 $3.6800 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.511111 $14.7800 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.511111 $10.7500 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.511111 $31.1800 $61.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 6.000000 $300.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 6 27.280952 $1364.0500 $50.0000
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Subtotal (Total Children Is Unduplicated) 8 14 36.858729 $1754.0100 $47.5900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 99 157 243.011111 $12150.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 24 31 32.000000 $800.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 130 143 203.125864 $10156.3000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 0.447185 $11.1800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 101 107 116.618254 $5830.9100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 57 60 68.366341 $3418.3200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.450000 $11.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 112 117 179.376189 $8968.8100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.511111 $37.7800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 9.571429 $478.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 298 346 2951.742850 $147587.3000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 31 38 329.638095 $23720.7600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 41 48 421.044048 $30298.3800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 26.285714 $1891.5300 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.511111 $58.6800 $114.8100
SENS -V5264 EARMOLD 1 1 0.511111 $9.2700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 91 103 889.821432 $64031.6100 $71.9600
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Subtotal (Total Children Is Unduplicated) 610 1164 5477.031845 $309586.1800 $56.5200
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Total 1230 5647.128670 $311340.1900 $55.1300
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Number of Children (Unduplicated) With at Least One Authorization 659