Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 3884 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 0.866667 $32.2400 $37.2000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 8 8 7.377777 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 8.244444 $32.2400 $3.9100
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 54 57 57.000000 $1112.0700 $19.5100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 39 42 42.000000 $616.5600 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 38 41 41.000000 $361.2100 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 38 41 41.000000 $1185.7200 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 38 41 41.000000 $862.6400 $21.0400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 9 9 9.000000 $676.1700 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 21 26 55.406353 $2770.3400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 40 45 44.944444 $2310.5900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 7 7 7.000000 $359.8700 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 56 63 80.869841 $4157.5200 $51.4100
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Subtotal (Total Children Is Unduplicated) 170 374 421.220638 $14573.8200 $34.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 4 4 4.000000 $20000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.000000 $50.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 633 896 1214.925407 $60746.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 86 111 129.504760 $6475.2300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 189 243 289.588887 $14479.4400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 425 560 712.360327 $35618.0600 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 43.525397 $2176.2700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 0.177778 $8.8900 $50.0100
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 687 942 8873.746028 $443687.5200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 0.588889 $29.4500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 157 201 1729.903980 $124483.8800 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 11.142857 $801.8400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 127 161 1106.121432 $79596.4700 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 283 372 2916.162709 $209847.0600 $71.9600
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Subtotal (Total Children Is Unduplicated) 1380 3501 17033.748451 $998230.0400 $58.6000
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Total 3884 17463.213533 $1012836.1000 $58.0000
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Number of Children (Unduplicated) With at Least One Authorization 1407