Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 4969 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 1 1 0.833333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.833333 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 62 65 65.000000 $1268.1500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.6700 $23.6700
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 93 98 123.285714 $9262.4500 $75.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.133333 $56.6700 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 65 70 68.900001 $3542.1500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 7 9 9.000000 $462.6900 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 74 86 109.630159 $5636.0900 $51.4100
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Subtotal (Total Children Is Unduplicated) 261 330 377.949207 $20251.8700 $53.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 4.066667 $203.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 490 657 773.618663 $38681.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 61 80 122.502385 $6125.1400 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 145 173 174.761109 $8738.0500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 330 411 540.314297 $27015.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.033333 $0.8300 $24.9800
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 38.571428 $964.2900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1660 2237 21429.087653 $1071454.9000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 236 287 2342.785717 $168586.8800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 233 276 1758.712717 $126556.8500 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 405 510 3981.937314 $286540.3200 $71.9600
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Subtotal (Total Children Is Unduplicated) 2041 4638 31168.391283 $1744867.3600 $55.9800
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Total 4969 31547.173823 $1765119.2300 $55.9500
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Number of Children (Unduplicated) With at Least One Authorization 2061