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 8637 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 115 129 526.270635 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 5 171.428572 $6342.8500 $37.0000
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Subtotal (Total Children Is Unduplicated) 119 134 697.699207 $6342.8500 $9.0900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 61 81 68.885085 $3340.9300 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.044444 $0.8800 $19.6900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.044444 $1.0400 $23.4700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.044444 $0.6200 $13.8600
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.044444 $1.0500 $23.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 3 0.296499 $2.6900 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.044444 $1.2400 $27.8000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.044444 $1.7100 $38.4300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 2 0.252055 $21.3900 $84.8600
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 2 0.252055 $12.8700 $51.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.044444 $0.7400 $16.6800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 0.282800 $6.3300 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 0.296499 $13.3400 $45.0000
EXIT -EXIT EXIT ASSESSMENT 186 190 380.000000 $19000.0000 $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 3 3 6.000000 $450.0000 $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 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $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 4 4 7.500000 $416.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 22 22 43.500000 $3262.5000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 11 11 21.500000 $1612.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 36 38 74.000000 $4107.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 32 36 71.500000 $5362.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 4.000000 $204.2000 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
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Subtotal (Total Children Is Unduplicated) 312 421 704.076101 $39590.9900 $56.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 7 3.718036 $18590.0000 $4999.9500
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 7 8 5.296499 $264.8300 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 6.142857 $1412.8700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 318 372 442.317526 $22115.8700 $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 333 417 999.732558 $49986.7300 $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 126 165 386.587304 $19329.3800 $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 152 191 443.779378 $22189.0300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 5 5 5.166666 $258.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 5 6 15.033334 $375.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 254 317 712.460332 $35623.1000 $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 -T1027SC EI INDIVIDUAL SESSION BY EI PROF 114 140 1062.157136 $53107.9100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 2.466667 $123.3400 $50.0000
INTR -T1013 INTERPRETER 149 188 913.446051 $45672.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1661 3010 20528.797535 $205288.1900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 16 97.819043 $6988.2100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 8.285714 $591.9300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 3.866667 $221.1800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 15 18 173.895236 $12423.0700 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 1 2 17.142857 $1224.6900 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 36 42 298.314283 $21311.6200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 3 11.409523 $815.0900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 4 4 14.795238 $205.3600 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 5.571429 $206.1400 $37.0000
TRAV -TRAVS Travel by mile 1665 3016 20541.392774 $9140.9300 $0.4500
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Subtotal (Total Children Is Unduplicated) 1730 8082 46925.838548 $534385.8700 $11.3900
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Total 8637 48327.613856 $580319.7100 $12.0100
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Number of Children (Unduplicated) With at Least One Authorization 1813