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: 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 9608 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 0.422222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.422222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 5 5.000000 $79.2000 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 95 99 99.000000 $1931.4900 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 5 5.000000 $118.3500 $23.6700
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 992 1085 1149.250490 $86343.1800 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 6 9.777777 $488.8900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 4.571429 $235.0200 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 207 268 298.207937 $15330.8700 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.733333 $37.7000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 43 54 65.223810 $3353.1600 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 270 349 361.486626 $18584.0200 $51.4100
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Subtotal (Total Children Is Unduplicated) 1323 1874 1999.251402 $126547.1800 $63.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 12 26.142857 $130714.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.866667 $43.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 560 743 855.638888 $42781.9400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 67 81 141.173808 $7058.6900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 157 195 205.595239 $10279.7700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 376 464 569.362701 $28468.1500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 449 536 5607.880198 $280393.7700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 8.142857 $407.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1496 2062 18279.373071 $913968.3500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 5 20.707936 $1035.4000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 689 1078 7946.279349 $571814.1000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 683 1017 6403.874925 $460822.9500 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 997 1537 11345.792847 $816442.9100 $71.9600
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Subtotal (Total Children Is Unduplicated) 2601 7733 51411.831343 $3264256.0100 $63.4900
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Total 9608 53411.504967 $3390803.1900 $63.4800
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Number of Children (Unduplicated) With at Least One Authorization 2619