Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2723 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 118 129 89.383326 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 118 129 89.383326 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 31 41 42.460318 $2059.3200 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.005479 $0.0900 $15.9000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 14.309524 $413.8300 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 5.761948 $667.3100 $115.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 47 57 26.600001 $1367.5100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 44 48 28.705554 $1475.7500 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 92 119 63.538891 $3266.5500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.277778 $65.6900 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 181 235 151.456565 $7786.3700 $51.4100
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Subtotal (Total Children Is Unduplicated) 336 512 334.116058 $17102.4200 $51.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 41 32.199999 $160999.5000 $4999.9800
CONIF -CONIF CONSULT, ITDS FACE TO FACE 38 42 63.205557 $3160.2900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 156 214 307.744440 $15387.2000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 87 110 143.366662 $7168.3100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 184 234 398.836509 $19941.8400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 -26.285714 $-1314.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 632 901 4993.780956 $249689.2700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 3 13.714286 $685.7200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 49 77 412.390473 $29675.6600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 129 192 977.017464 $70306.2400 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 5 7 4.326940 $993.5200 $229.6100
SENS -V5264 EARMOLD 5 7 2.544293 $46.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 185 253 1423.158728 $102410.5400 $71.9600
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Subtotal (Total Children Is Unduplicated) 959 2082 8746.000593 $659149.9200 $75.3700
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Total 2723 9169.499977 $676252.3500 $73.7500
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Number of Children (Unduplicated) With at Least One Authorization 1063