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: 07-01-23 and 09-30-23 Date of Report: 10-10-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1385 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 27 28 32.150001 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 27 28 32.150001 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 20 18.855555 $914.4900 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.8400 $15.8400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.494444 $7.2600 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 9 5.455555 $120.4000 $22.0700
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 2.785714 $348.2100 $125.0000
EXIT -EXIT COS Exit 1 1 1.000000 $50.0000 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 33 33 29.591268 $1456.2100 $49.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 8 7.988888 $39944.0000 $4999.9400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 13 15 26.526189 $1326.3100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 7 7 5.633333 $281.6700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 8.844446 $442.2300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 4 3.788889 $189.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 94 107 210.253649 $10512.6700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 5.377778 $268.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.533333 $38.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 56 90.642064 $4532.1100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.666666 $133.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 63 73 111.491266 $5574.5400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 27.619049 $690.4800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 7 46.638096 $2331.9100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 60 66 494.261902 $24713.1200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 8.919047 $445.9500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 691 919 5614.266616 $67371.2200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 13 88.228571 $6348.9300 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 4 4 32.457143 $2335.6200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 3.133333 $225.4700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 3 3 22.142857 $1593.4000 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12 13 107.585713 $7741.8700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.733333 $196.6900 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 9.857143 $709.3200 $71.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 725 1324 6934.589304 $178022.4800 $25.6700
-------------------------------------------------------------------------------------------------------------------------------------
Total 1385 6996.330573 $179478.6900 $25.6500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 743