Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 4814 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 79 89 135.435715 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 79 89 135.435715 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 3.066667 $172.0400 $56.1000
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 9 9.022222 $1044.8600 $115.8100
EXIT -EXIT COS Exit 2 2 3.000000 $150.0000 $50.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 47 52 71.077776 $10109.3700 $142.2300
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Subtotal (Total Children Is Unduplicated) 52 64 86.166665 $11476.2700 $133.1900
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 17 18 26.684129 $1850.5500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 5.988889 $415.3300 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 180 201 139.178078 $6958.9300 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 67 74 76.687303 $3834.3800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 142 148 72.505820 $1812.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 35 41 77.616667 $3880.8400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 13 17 34.069049 $1703.4600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 12 13 15.072221 $376.8000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 17 22 45.614287 $2280.7200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 9 11 22.138096 $1106.9100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 9 10.272222 $256.8100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 14 26.516666 $1325.8300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 1.533333 $76.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 5 11.278571 $281.9700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 10 22.083335 $1104.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 4 3.150000 $78.7500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 50 64 1966.428576 $49160.7000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 39 45 1517.714288 $37942.8500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 16.571428 $828.5800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 44.428571 $2221.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1125 1516 12162.633331 $608132.1100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 72 88 565.761906 $28288.1100 $50.0000
INTR -T1013 INTERPRETER 61 85 470.671428 $23533.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1228 1735 13754.942853 $165059.4500 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 69 473.493651 $34072.6300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 18 20 122.596827 $8822.0700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 18 25 151.764286 $8741.6200 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 6 6 45.035715 $2594.0500 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 72 98 605.642856 $43582.0800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 14 16 70.492858 $5072.6500 $71.9600
PHY -97110HM PT SESSION BY PT ASST 19 24 156.100002 $8985.1100 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 10 12 79.857144 $4596.5800 $57.5600
SENS -V5060 BEHIND EAR HEARING AID 8 8 8.000000 $1836.8800 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 38 47 80.195237 $1453.9400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 141 176 1241.516674 $89339.5600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 21 24 161.750000 $11639.5400 $71.9600
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Subtotal (Total Children Is Unduplicated) 1492 4661 34291.986297 $1165093.1300 $33.9800
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Total 4814 34513.588677 $1176569.4000 $34.0900
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Number of Children (Unduplicated) With at Least One Authorization 1552