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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2861 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 113 127 92.427774 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 113 127 92.427774 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 27 29 26.865874 $1303.0000 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.476712 $7.5500 $15.8400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 3.655556 $105.7200 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 0.298630 $34.5800 $115.8000
OCTH -97165 OT EVAL LOW COMPLEXITY 56 72 43.211113 $2221.4900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 49 56 31.133339 $1600.5900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 73 99 58.972224 $3031.7700 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 3 4 6.761904 $347.6300 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 132 185 106.047464 $5451.9400 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 291 454 278.422816 $14155.6800 $50.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 28 22.746500 $113733.0000 $5000.0200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 42 47 65.366666 $3268.3300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 203 261 367.033314 $18351.5700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 88 115 151.547609 $7577.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 194 251 350.599992 $17529.9600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 710 1070 5582.253971 $279112.7400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 62 85 509.884125 $36691.2800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 118 197 876.333335 $63060.9900 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 3 4 1.330593 $305.5000 $229.5900
SENS -V5264 EARMOLD 3 4 1.273972 $23.1000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 141 218 1053.716667 $75825.5000 $71.9600
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Subtotal (Total Children Is Unduplicated) 997 2280 8982.086744 $615479.2800 $68.5200
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Total 2861 9352.937334 $629634.9700 $67.3200
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Number of Children (Unduplicated) With at Least One Authorization 1104