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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5616 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 91 104 131.301588 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 91 104 131.301588 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 11 12.000000 $1389.7200 $115.8100
EXIT -EXIT EXIT ASSESSMENT 7 7 12.088889 $604.4500 $50.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 1 1.000000 $51.8500 $51.8500
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 55 71 94.100000 $13383.8400 $142.2300
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.1100 $15.1100
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Subtotal (Total Children Is Unduplicated) 63 91 120.188889 $15444.9700 $128.5100
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 1.333334 $66.6700 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 301 313 193.141976 $9657.1800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 21 21 10.433335 $521.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 167 178 110.369357 $2759.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 35 42 75.804365 $3790.2200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 4 5 5.416667 $270.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 29 39 54.165625 $1354.1500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 19 23 35.266666 $1763.3300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 3 4 5.366667 $268.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 21 25 47.037053 $1175.9300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 15 17 30.390476 $1519.5200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 2 2 2.100000 $105.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 10 11 9.276192 $231.9100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 7 8.416667 $420.8400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 8 19.669048 $491.7300 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 37 47 1325.428571 $33135.7100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 32 42 1130.571430 $28264.3000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1251 1727 12519.871453 $625993.2900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 43 48 365.714287 $18285.7000 $50.0000
INTR -T1013 INTERPRETER 41 53 446.714287 $22335.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1400 2062 14848.051619 $148480.4500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 104 139 652.906349 $46983.0900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 11 13 39.642064 $2852.6500 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 30 41 244.395236 $14077.1600 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 9 9 40.250000 $2318.3900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 96 135 747.959318 $53823.1900 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 13 16 68.678571 $4942.1100 $71.9600
PHY -97110HM PT SESSION BY PT ASST 25 36 138.233336 $7956.7000 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 8 10 59.321428 $3414.5400 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 1.000000 $71.9600 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 7 8 10.000000 $2296.1000 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 5 5.000000 $2296.1000 $459.2200
SENS -V5264 EARMOLD 35 47 67.755556 $1228.4100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 155 223 1415.725391 $101875.5700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 37 51 281.983329 $20291.5300 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.428571 $82.2900 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 1.142857 $65.8300 $57.6000
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 18.928571 $264.2400 $13.9600
TRAV -TRAVS Travel by mile 2 2 6.285714 $2.8000 $0.4400
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Subtotal (Total Children Is Unduplicated) 1612 5421 35049.175366 $1166660.8700 $33.2900
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Total 5616 35300.665843 $1182105.8300 $33.4900
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Number of Children (Unduplicated) With at Least One Authorization 1690