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 3711 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 -92552 PURE TONE AUDIOMETRY -AIR ONLY 13 14 14.000000 $273.1400 $19.5100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 110 115 135.428571 $10174.7500 $75.1300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 6 9.777777 $488.8900 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 58 72 92.758730 $4768.7200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 8 11 11.000000 $565.5100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 77 95 100.142857 $5148.3500 $51.4100
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Subtotal (Total Children Is Unduplicated) 229 313 363.107935 $21419.3600 $58.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.000000 $20000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.866667 $43.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 558 740 849.705555 $42485.2800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 66 80 140.529364 $7026.4700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 157 195 205.595239 $10279.7700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 376 463 568.462701 $28423.1500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 421 494 5423.673847 $271183.4700 $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 332 446 3371.180152 $168558.9900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 212 271 2104.007935 $151404.3200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 192 241 1418.209912 $102054.3200 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 343 460 3388.359523 $243826.2500 $71.9600
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Subtotal (Total Children Is Unduplicated) 1370 3397 17483.733752 $1045717.4900 $59.8100
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Total 3711 17847.263909 $1067136.8400 $59.7900
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Number of Children (Unduplicated) With at Least One Authorization 1406