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 1288 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 21 26 27.460318 $1331.8200 $48.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.252055 $29.2000 $115.8300
OCTH -97165 OT EVAL LOW COMPLEXITY 7 8 3.216667 $165.3700 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 7 8 3.772223 $193.9300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 8 5.811111 $298.7500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.277778 $14.2800 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 31 42 28.488892 $1464.6300 $51.4100
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Subtotal (Total Children Is Unduplicated) 66 94 69.279044 $3497.9900 $50.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 9 5.411111 $27055.5000 $4999.9900
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 248 365 1967.790473 $98389.6200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 6.142857 $307.1500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 12 66.990477 $4820.6400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 21 26 100.814287 $7254.6000 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.252055 $57.8800 $229.6500
SENS -V5264 EARMOLD 1 1 0.252055 $4.5700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 35 48 220.323808 $15854.5100 $71.9600
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Subtotal (Total Children Is Unduplicated) 559 1065 3254.844577 $198087.8200 $60.8600
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Total 1288 3413.506947 $201585.8100 $59.0600
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Number of Children (Unduplicated) With at Least One Authorization 680