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: 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 1131 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 51 58 113.971429 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 51 58 113.971429 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 2 0.500000 $9.7600 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 0.500000 $11.8400 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 2 0.500000 $7.3400 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 2 0.500000 $3.6000 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 2 0.500000 $14.4600 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 2 0.500000 $10.5200 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 2 0.500000 $30.5000 $61.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 2.428571 $121.4300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 7 29.428571 $1471.4300 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 7 22 35.357142 $1680.8700 $47.5400
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 93 147 220.348554 $11017.4300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 29 34 29.755480 $743.8900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 140 150 158.242738 $7912.1500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 0.988889 $24.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 98 100 106.362698 $5318.1300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 56 59 52.410992 $2620.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 123 127 151.316669 $7565.8400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 1.044444 $26.1100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 2.714286 $135.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 211 274 2004.257149 $100212.8100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 28 38 235.961906 $16979.7900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 26 30 231.649998 $16669.5400 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.377778 $43.3800 $114.8200
SENS -V5264 EARMOLD 1 2 0.500000 $9.0700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 70 83 650.035716 $46776.5400 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 505 1051 3846.967297 $216080.6500 $56.1700
-------------------------------------------------------------------------------------------------------------------------------------
Total 1131 3996.295868 $217761.5200 $54.4900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 555