Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 5533 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 60 63 655.087303 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 82 87 10486.700000 $388007.9000 $37.0000
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Subtotal (Total Children Is Unduplicated) 140 150 11141.787303 $388007.9000 $34.8200
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.367732 $106.5500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.288888 $263.2100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 40 43 41.711263 $2085.5600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 3 6.000000 $300.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 64 67 121.142857 $6057.1500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 9 9 16.011111 $1200.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $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 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 6.011111 $333.6200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 33 33 66.000000 $4950.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 268 270 558.000000 $41850.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 34 34 68.000000 $5100.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 108 110 220.000000 $16500.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 14 28.000000 $2100.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 51 51 120.000000 $9000.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 42 43 85.000000 $4717.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 69 71 142.000000 $7881.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 95 111 39.261108 $2004.2700 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 12 13 4.622221 $235.9600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 14 20.213492 $1031.9000 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 5 5 3.505555 $178.9600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 110 124 60.772218 $3102.4000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 39 43 12.478245 $637.0200 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 6 7 3.372222 $172.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 3.116666 $159.1000 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.188889 $9.6400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 49 58 32.772222 $1673.0200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 13.142857 $670.9500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 2.394444 $122.2300 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.511111 $26.0900 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.411111 $20.9900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 225 246 110.816801 $5657.1500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 31 32 14.105553 $720.0800 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.438889 $22.4100 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 7 8 3.549999 $181.2200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 1.650000 $73.5100 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.100000 $4.4600 $44.5500
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Subtotal (Total Children Is Unduplicated) 767 1450 1832.117676 $120807.1300 $65.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 7 8 5.927777 $29638.5000 $4999.9400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 3.288888 $164.4400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.655556 $32.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 2.211111 $508.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 10 4.394443 $219.7200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 6 5.000000 $250.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 8 10 3.105559 $77.6500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 349 425 347.372201 $17368.5100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 4 5 3.066666 $153.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 316 370 480.953959 $12023.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 200 413 316.519019 $15825.8200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 1.261111 $63.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 107 212 289.701601 $7242.5700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 55 132 94.855556 $4742.7800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 104 122.094443 $3052.3600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 300 351 297.922202 $14896.0100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 5 5 3.005555 $150.2800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 301 346 414.799989 $10369.9700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 4 24.022222 $600.5600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 420 509 4510.550765 $225527.8600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 18 18 171.857142 $8592.8800 $50.0000
INTR -T1013 INTERPRETER 2 3 6.285714 $314.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 174 202 1561.076181 $111523.3800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 15 17 81.642857 $5832.5700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 156 190 1874.469045 $107219.7300 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 9 11 83.714286 $4788.4600 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 3.857143 $275.5500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 51 63 528.082535 $37726.2600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 3 10.285715 $734.8100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 64 85 753.785713 $43086.4200 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 6 6 48.999999 $2800.8500 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.394521 $317.9500 $228.0000
SENS -V5264 EARMOLD 5 5 6.022221 $108.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 286 360 3049.009508 $217821.5100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 14 14 129.857142 $9277.0000 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 24 26 249.857141 $17849.8200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 4 16.714286 $1194.0700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 2 2 17.428571 $241.9100 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 4.000000 $148.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 858 3933 15531.048343 $913218.3900 $58.8000
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Total 5533 28504.953322 $1422033.4200 $49.8900
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Number of Children (Unduplicated) With at Least One Authorization 1070