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 3500 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 57 80 70.576985 $3422.9800 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $28.9200 $28.9200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 0.958904 $111.0500 $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 16 28 20.050002 $1030.7800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 3 0.951750 $48.9300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 11 14 9.616667 $494.3900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 28 18.077776 $929.3700 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.022222 $52.5500 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 44 75 57.746826 $2968.7700 $51.4100
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Subtotal (Total Children Is Unduplicated) 124 235 181.001132 $9143.2500 $50.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 25 21.072223 $105361.5000 $5000.0200
CONIF -CONIF CONSULT, ITDS FACE TO FACE 92 129 272.885711 $13644.2700 $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 3 3 20.000000 $1000.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 460 1044 8397.131736 $419856.7200 $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 17 33 318.780951 $22939.4900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 30 55 386.433334 $27807.7500 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 1.317808 $302.5800 $229.6100
SENS -V5264 EARMOLD 3 3 1.676712 $30.4000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 59 90 576.995237 $41520.5900 $71.9600
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Subtotal (Total Children Is Unduplicated) 1113 2948 13333.100847 $799303.6000 $59.9500
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Total 3500 13921.428163 $808446.8500 $58.0700
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Number of Children (Unduplicated) With at Least One Authorization 1329