Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 2745 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.008333 $0.3100 $37.0600
SCONLY-SCONLY *SERVICE COORDINATION ONLY 21 23 27.916668 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.600000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 23 25 29.525001 $0.3100 $0.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 14 15 10.522222 $510.3300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.214286 $124.2200 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 7 7.000000 $136.5700 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 0.638889 $15.1200 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 0.683333 $10.0300 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 107 116 60.672218 $1339.0300 $22.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 2 0.638889 $13.4400 $21.0400
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $189.0300 $52.9300
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Subtotal (Total Children Is Unduplicated) 127 147 85.941266 $2337.7800 $27.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 15 12.055556 $60278.0000 $5000.0200
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 7.361112 $1705.0000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 13 20 22.970636 $1148.5300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 3.142857 $157.1500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 12 16 11.808334 $590.4200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 2 1.866666 $93.3300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 110 125 140.758732 $7037.9500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 4 5 10.000000 $500.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 4.483334 $112.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 48 58 99.005555 $4950.2800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 2 2 3.500000 $175.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 50 58 74.323017 $3716.1500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.238889 $11.9500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 16.940477 $423.5100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 34 41 184.711903 $9235.5900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 508 605 3899.157157 $194957.5900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 43 48 275.071435 $13753.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 773 1215 6570.327806 $65703.2100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 55 69 439.780955 $31646.6300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 4.571429 $328.9600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 25 32 201.647620 $14510.5500 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 5 6 38.085715 $2740.6400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 44 54 325.480952 $23421.6200 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 31 32 243.021431 $17487.7900 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 3 5 48.857143 $3515.7700 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.600000 $275.5300 $459.2200
SENS -V5264 EARMOLD 3 3 4.600000 $83.4000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 82 93 569.750792 $40999.2300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 6 55.428571 $3988.6400 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 28 34 212.438097 $15287.0200 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 7.288889 $524.5100 $71.9600
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Subtotal (Total Children Is Unduplicated) 815 2573 13489.275060 $519359.5700 $38.5000
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Total 2745 13604.741327 $521697.6600 $38.3500
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Number of Children (Unduplicated) With at Least One Authorization 832