Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5935 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 1 1 0.084932 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 1 1 0.084932 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 58 82 58.976409 $2860.3600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 6 4.763166 $265.3600 $55.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 4 4.000000 $58.3200 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 8 6.823744 $160.3600 $23.5000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.722222 $77.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.400000 $46.0000 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 0.494444 $24.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 77 77 90.026353 $4501.3300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 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 -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 5 6 12.000000 $666.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 108 108 193.780034 $14533.5200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 29 29 59.214286 $4441.0700 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 5 5 11.000000 $825.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 129 136 250.494320 $13902.4500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.500000 $83.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 39 43 87.000000 $6525.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 6 1.944369 $99.2600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 11 13 12.327778 $629.3300 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 1.511111 $77.1400 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 2 0.511111 $26.0900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 21 23 12.753881 $651.0900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 71 85 54.486149 $2781.5200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 4 1.405480 $71.7500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.511111 $77.1400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 22 25 17.557566 $896.3200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 42 52 29.408981 $1501.3300 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 19 20 20.000000 $1021.0000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 5 3.338888 $170.4500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 87 100 71.861274 $3668.5100 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.252055 $12.8700 $51.0600
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 0.722222 $36.8700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 28 33 23.856936 $1062.8200 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 5 2.684932 $119.6200 $44.5500
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Subtotal (Total Children Is Unduplicated) 426 896 1049.328822 $62674.4200 $59.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 71 102 102.425898 $512130.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.494445 $124.7300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 4 3.252055 $223.9400 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 5 6 3.554110 $817.4700 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 62 62 68.268538 $3413.4300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 7 8 11.500000 $575.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 5.822223 $145.5600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 463 664 1520.633781 $76031.9300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 3 3 10.847620 $542.3900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.800000 $45.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 233 299 622.614311 $31130.8300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 36 40 102.885718 $5144.3100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.133333 $153.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 66 166.307944 $8315.4300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 5 7.266666 $181.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 406 524 1098.600838 $54930.2600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 11 13 27.466668 $1373.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 9.233334 $230.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 476 614 5041.093625 $252055.0400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 2.285714 $114.2900 $50.0000
INTR -T1013 INTERPRETER 17 27 109.483821 $5474.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 474 997 6009.295244 $60093.0600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 130 160 1478.680941 $105637.1400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 11 14 118.428570 $8460.5600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 7 7 66.214285 $3787.4700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 10.857143 $775.6300 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 11.142857 $796.0500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 84 108 1039.171424 $74238.5100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 6 7 59.080952 $4220.7500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 7 58.138096 $3323.1800 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 2 15.428571 $881.9000 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 3 3 1.652055 $376.6800 $228.0100
SENS -V5264 EARMOLD 3 3 2.567275 $46.2100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 176 210 1924.957132 $137519.1700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 12.620635 $901.6200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 13.142857 $751.7700 $57.2000
SPL -92508HA GROUP SPL SESSION PER CHILD 6 8 80.285714 $1114.3700 $13.8800
TRAV -TRAVS Travel by mile 475 1052 305364.641028 $135887.2700 $0.4500
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Subtotal (Total Children Is Unduplicated) 594 5038 325191.275421 $1492014.2900 $4.5900
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Total 5935 326240.689175 $1554688.7100 $4.7700
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Number of Children (Unduplicated) With at Least One Authorization 643