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 1380 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 20 22 20.360318 $987.4700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $28.9200 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.249315 $28.8700 $115.8000
OCTH -97165 OT EVAL LOW COMPLEXITY 11 14 7.466666 $383.8600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 8 8 4.055556 $208.5000 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 12 16 10.694444 $549.8000 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 23 31 18.313493 $941.5000 $51.4100
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Subtotal (Total Children Is Unduplicated) 59 94 63.139792 $3180.3300 $50.3700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 9 6.733334 $33667.0000 $5000.0500
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 266 389 2091.180954 $104559.0600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 14 67.238095 $4838.4500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 23 31 106.804764 $7685.6900 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.498630 $114.4800 $229.6000
SENS -V5264 EARMOLD 1 1 0.747945 $13.5600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 31 40 170.752378 $12287.3400 $71.9600
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Subtotal (Total Children Is Unduplicated) 611 1159 3378.503681 $209892.7700 $62.1300
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Total 1380 3534.071247 $213073.1000 $60.2900
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Number of Children (Unduplicated) With at Least One Authorization 730