Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2612 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 131 146 96.087300 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 131 146 96.087300 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 33 36 29.235085 $1417.9100 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 4.000000 $115.6800 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 1.071233 $124.0700 $115.8200
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.000000 $55.5000 $55.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 48 65 31.316669 $1610.0000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.077778 $4.0000 $51.4200
PSTH -97161 PT EVAL LOW COMPLEXITY 40 48 24.888890 $1279.5400 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 51 65 28.844442 $1482.8800 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 7.142858 $367.2100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 124 171 84.873140 $4363.3500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.183333 $8.2200 $44.8500
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Subtotal (Total Children Is Unduplicated) 251 399 213.633428 $10879.7800 $50.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 35 27.341019 $136705.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 30 32 42.177779 $2108.9000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 167 224 270.900005 $13545.0300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 78 106 137.922223 $6896.1200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 189 254 340.526985 $17026.3500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 657 1001 5070.263505 $253513.0300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 51 78 373.960316 $26910.1700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 91 131 662.147621 $47648.1200 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 3.786302 $869.4000 $229.6200
SENS -V5264 EARMOLD 4 4 1.142466 $20.7200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 127 198 833.495235 $59978.2800 $71.9600
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Subtotal (Total Children Is Unduplicated) 904 2067 7763.663456 $565221.0900 $72.8000
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Total 2612 8073.384184 $576100.8600 $71.3600
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Number of Children (Unduplicated) With at Least One Authorization 1021