Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 12285 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 126 143 549.854760 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 34 40 1317.479372 $48746.7300 $37.0000
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Subtotal (Total Children Is Unduplicated) 156 183 1867.334132 $48746.7300 $26.1000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 66 87 74.023974 $3590.1700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 2.044444 $40.3000 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 2.044444 $48.0200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 2.044444 $28.3600 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 4.494444 $106.5200 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 6 3.296499 $29.9300 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.044444 $29.0700 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 2.044444 $78.6500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 7 9 6.740944 $571.9100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 6 7 7.394912 $377.6600 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 2.044444 $34.1400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 3.282800 $73.5300 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 8 6.363166 $286.3400 $45.0000
EXIT -EXIT EXIT ASSESSMENT 188 192 384.000000 $19200.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 30 30 56.500000 $4237.5000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 3.500000 $262.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 34 47 87.500000 $6562.5000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 21 24 47.500000 $2636.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 214 214 413.000000 $30975.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 16 16 32.000000 $2400.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 88 88 170.500000 $12787.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 323 327 625.642857 $34723.1800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 9 9 18.000000 $999.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 281 317 601.133334 $45085.0100 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 21.000000 $1575.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 4.572603 $233.4300 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.175342 $8.9500 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.1000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 5.000000 $255.2500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.057534 $2.9400 $51.0200
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 11 15.714285 $802.2200 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 4 17.573907 $263.6100 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 5.000000 $255.2500 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 4.000000 $204.2000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 25 25 20.499804 $1046.5200 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 7.884150 $402.4800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 7.000000 $311.8500 $44.5500
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Subtotal (Total Children Is Unduplicated) 844 1527 2721.617219 $174469.8600 $64.1100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 53 65 68.129528 $340647.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 17 20 24.433530 $1221.6800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 21 24 35.370255 $8135.1700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 326 384 460.067526 $23003.3700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 8 9 1.535615 $76.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 64 71 77.744000 $1943.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 337 421 1008.432559 $50421.7400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 13 13 23.483334 $1174.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 13 15 20.066667 $501.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 129 168 393.287305 $19664.3900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 5 5 9.833333 $491.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 12 12 46.314288 $1157.8600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 156 196 456.879379 $22844.0400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 5 5 5.166666 $258.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 6 7 18.100001 $452.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 258 321 724.026999 $36201.4300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 8 9 15.699999 $785.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 15 16 31.566669 $789.1700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 1.142857 $57.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1427 1814 14141.309438 $707066.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 22 22 143.161904 $7158.1100 $50.0000
INTR -T1013 INTERPRETER 172 215 1006.538114 $50326.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1663 3014 20567.349915 $205673.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 91 128 889.359521 $63535.8900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 21.428571 $1530.8600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 15.295238 $874.8900 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 3 4 26.171428 $1869.6900 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 12.409524 $886.5400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 149 200 1606.852375 $114793.6500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 13.142857 $938.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 5.266667 $301.0400 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 3 4 27.714285 $1979.9200 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 12.999999 $928.7200 $71.4400
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 2 0.227398 $25.9200 $114.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 5.000000 $2280.0000 $456.0000
SENS -V5264 EARMOLD 6 8 23.010438 $414.1900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 255 313 2585.633320 $184717.8400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 12 14 88.590475 $6328.9100 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 5 29.990476 $2142.5100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 13 14 108.180952 $7728.4600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 18 19 149.938094 $2081.1500 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.571429 $77.3300 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 5.571429 $206.1400 $37.0000
TRAV -TRAVS Travel by mile 1666 3019 20573.811821 $9155.3600 $0.4500
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Subtotal (Total Children Is Unduplicated) 1753 10575 65486.806178 $1882900.0800 $28.7500
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Total 12285 70075.757529 $2106116.6700 $30.0500
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Number of Children (Unduplicated) With at Least One Authorization 1937