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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 7486 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 245 317 407.326184 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 245 317 407.326184 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 69 102 89.074702 $4320.1200 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.476712 $7.5500 $15.8400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 8 8 7.655556 $221.4000 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 8 3.526028 $408.3500 $115.8100
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.000000 $55.5000 $55.5000
OCTH -97165 OT EVAL LOW COMPLEXITY 105 175 118.368112 $6085.3000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 16 8.179527 $420.5000 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 109 173 122.384921 $6291.8100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 110 190 121.288891 $6235.4700 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 7 8 14.749206 $758.2500 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 271 509 342.654248 $17615.8400 $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 2 1.205555 $61.9700 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 6.857143 $352.5200 $51.4100
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Subtotal (Total Children Is Unduplicated) 540 1195 838.420601 $42886.0000 $51.1500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 65 94 84.541937 $422712.0000 $5000.0300
CONIF -CONIF CONSULT, ITDS FACE TO FACE 93 130 276.585711 $13829.2700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 365 571 1194.611106 $59730.5300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 169 297 618.069838 $30903.4800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 405 694 1506.269048 $75313.4600 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 30.666667 $1533.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1253 2876 22224.596810 $1111230.0400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 17.857143 $892.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 114 227 1988.476191 $143090.7900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 192 457 3390.055565 $243948.4300 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 8 10 8.932877 $2051.0600 $229.6100
SENS -V5264 EARMOLD 7 9 4.391781 $79.6200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 279 604 3918.173802 $281951.8200 $71.9600
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Subtotal (Total Children Is Unduplicated) 1745 5974 35263.228476 $2387266.6700 $67.7000
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Total 7486 36508.975261 $2430152.6700 $66.5600
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Number of Children (Unduplicated) With at Least One Authorization 1919