Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 3197 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
TCM -T1017TL TARGETED CASE MANAGEMENT 10 10 8.655556 $321.9900 $37.2000
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Subtotal (Total Children Is Unduplicated) 10 10 8.655556 $321.9900 $37.2000
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 7 6.966667 $315.7300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
OCTF -97168 OT RE-EVAL EST PLAN CARE 15 17 6.388889 $328.4500 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 22 22 9.783334 $502.9600 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 15 18 5.650001 $290.4700 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 15 19.353968 $994.9900 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 47 57 24.361112 $1252.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 79 137 73.503971 $3800.8300 $51.7100
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 9 3.033333 $151.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 842 991 952.234872 $47611.4800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 90 109 175.477771 $8773.8400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1043 1231 1025.780889 $51288.7500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 492 629 5159.792053 $257989.8100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 12 109.428572 $7874.4900 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 13.142857 $757.0300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 8 11 121.428572 $8738.0000 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 15 19 146.428573 $10537.0000 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 5 32.285716 $1859.6500 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 6.571429 $472.8800 $71.9600
TRAV -TRAVS Travel by mile 24 30 206.852380 $92.0500 $0.4500
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Subtotal (Total Children Is Unduplicated) 1339 3050 7954.457017 $396394.3800 $49.8300
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Total 3197 8036.616544 $400517.2000 $49.8400
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Number of Children (Unduplicated) With at Least One Authorization 1373