Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 1497 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 9 9 7.222222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 7.222222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 3 3.366667 $49.4200 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 3 3.366667 $29.6600 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 3 3.366667 $97.3700 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 3 3.366667 $70.8400 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 0.276713 $12.5400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 0.276713 $32.0400 $115.8000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 6 6 6.000000 $300.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 10 27 23.020094 $746.1000 $32.4100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 9 9 21.766667 $1088.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 396 557 1910.223816 $95511.2200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 238 316 1043.190474 $52159.5100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 147 211 755.999997 $37799.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 253 293 927.600002 $46380.0100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.466667 $123.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 13 41.390477 $1034.7600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 12.266666 $613.3300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 31 35 236.400000 $11820.0000 $50.0000
INTR -T1013 INTERPRETER 1 1 0.700000 $35.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 18.428572 $1326.1200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 16.133333 $1160.9500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 5 5 21.311904 $1533.6000 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 2 3 1.122222 $20.3500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 9 36.342857 $2615.2400 $71.9600
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Subtotal (Total Children Is Unduplicated) 499 1461 5047.343654 $254140.1900 $50.3500
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Total 1497 5077.585970 $254886.2900 $50.2000
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Number of Children (Unduplicated) With at Least One Authorization 512