Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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: 01-01-24 and 03-31-24 Date of Report: 04-04-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 954 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 56 60 148.349204 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 56 60 148.349204 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.466667 $12.1500 $26.0400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.466667 $10.8000 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.466667 $36.5200 $78.2600
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 4.066667 $203.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 10 66.633333 $3331.6700 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 5 6 40.571429 $2357.6000 $58.1100
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Subtotal (Total Children Is Unduplicated) 18 21 112.671430 $5952.0800 $52.8300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 101 154 239.071429 $11953.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 13 14 16.000000 $400.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 140 163 172.633336 $8631.6800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 75 81 89.816666 $4490.8300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 40 42 51.600000 $2580.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 99 110 106.722224 $5336.1200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 178 226 1650.052387 $89102.7900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 18 22 168.999999 $13743.0800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 9.142858 $595.3800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 20 26 238.530951 $19397.3600 $81.3200
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 33 275.785713 $22426.8900 $81.3200
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Subtotal (Total Children Is Unduplicated) 385 873 3018.355563 $178657.6900 $59.1900
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Total 954 3279.376197 $184609.7600 $56.2900
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Number of Children (Unduplicated) With at Least One Authorization 449