Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 1581 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 7 8 3.422222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 8 3.422222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 3 6.000000 $88.0800 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 3 6.000000 $43.2000 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 3 6.000000 $173.5200 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 3 6.000000 $126.2400 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 0.493150 $22.3500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 0.493150 $57.1200 $115.8200
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.000000 $100.0000 $50.0000
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 9 26 32.986300 $917.5600 $27.8200
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.333333 $116.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 11.000000 $550.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 415 574 1701.683339 $85084.2000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 2.166667 $108.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 256 354 1110.566672 $55528.3600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 154 214 739.833336 $36991.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 254 320 894.000004 $44700.0200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 3 4 7.666666 $383.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 15 17 33.800001 $845.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 5.285714 $264.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 19 24 140.485715 $7024.2800 $50.0000
INTR -T1013 INTERPRETER 3 3 20.285714 $1014.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 4 6 8.716666 $627.2500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 7.571429 $544.8400 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 2 3 24.714285 $1423.5500 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 3 3 23.571429 $1696.2000 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 2 3 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8 11 65.466666 $4710.9900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 13.285714 $956.0400 $71.9600
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Subtotal (Total Children Is Unduplicated) 506 1547 4815.433350 $243064.7800 $50.4800
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Total 1581 4851.841872 $243982.3400 $50.2900
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Number of Children (Unduplicated) With at Least One Authorization 515