Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 6948 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 53 57 92.693651 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 53 57 92.693651 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 30 31 33.000000 $1838.4300 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 31 31 33.933333 $797.4300 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 42 45 51.480060 $1209.7800 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 33 35 38.061111 $554.9300 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 38 40 43.883333 $1031.2600 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 62 67 62.103966 $608.0000 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 21 23 24.000000 $234.9600 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 81 87 79.192856 $2274.4200 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 32 35 39.933333 $1787.4100 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 22 22 25.000000 $2121.0000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 22 22 24.000000 $1225.6800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 110 121 111.937300 $1534.6600 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 106 109 183.272221 $3828.5600 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 14 14 21.351838 $960.8400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.211111 $24.2800 $114.9900
EXIT -EXIT EXIT ASSESSMENT 106 106 188.034738 $9401.7400 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 43 43 75.126331 $4169.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 37 37 65.104109 $4882.8000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 19 22 21.511111 $1098.1400 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 11.428571 $583.4300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 13 17 6.561112 $334.9500 $51.0500
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.005556 $0.2900 $51.4600
OCTH -97167 OT EVAL HIGH COMPLEXITY 107 122 96.585384 $4930.6600 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.166667 $8.5100 $51.0600
PSTF -97164 PT RE-EVAL EST PLAN CARE 12 13 13.233333 $675.5600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 12 7.805557 $398.4800 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 10.714286 $546.9700 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 64 76 73.160317 $3734.8400 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 9 10 9.411111 $480.4400 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 17 19 17.722221 $904.7100 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.1000 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 3 3 1.066667 $54.4600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 156 165 134.835386 $6883.3400 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.194444 $112.0200 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.372222 $121.1000 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.233333 $165.0600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 9 10 8.511111 $434.4900 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 55 62 49.177778 $2190.8700 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.472222 $110.1400 $44.5500
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Subtotal (Total Children Is Unduplicated) 730 1438 1608.794029 $64657.5800 $40.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 0.027778 $139.0000 $5003.9600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.266667 $63.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 14 14 19.303968 $965.2000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.266667 $87.2300 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 54 56 122.376189 $8426.8300 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 28 30 46.172221 $10619.5800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 240 339 254.860131 $12743.0900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 27 28 31.620816 $790.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 810 1060 3156.540320 $157827.2200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 4 4 15.200000 $760.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 6 8 9.300000 $232.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 392 478 1221.979802 $61099.1800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 6.300000 $315.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 6 15.766667 $394.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 158 205 525.424299 $26271.3200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 1 1 1.700000 $85.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 4 7.133333 $178.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 448 543 1310.028621 $65501.6600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 3 4 12.704762 $635.2500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 15.033334 $375.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1577 2001 19384.406275 $969221.1400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 9.714286 $485.7200 $50.0000
INTR -T1013 INTERPRETER 1 1 1.000000 $50.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 124 158 1419.752381 $101427.2100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 4 5 65.285715 $4664.0200 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 4 5 21.714287 $1551.2600 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 9.285714 $663.3700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 80 107 1004.235711 $71742.6900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 32.000000 $2286.0800 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 1 1 26.285714 $1877.8500 $71.4400
SENS -V5264 EARMOLD 1 1 1.266667 $22.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 267 327 3126.446817 $223353.6000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 8 9 87.857142 $6276.5100 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 5 47.714286 $3408.7100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 15 17 138.923808 $9924.7500 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 12 15 108.999999 $1512.9200 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 10.571429 $146.7300 $13.8800
TRAV -TRAVS Travel by mile 1 1 13.142857 $5.8500 $0.4500
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Subtotal (Total Children Is Unduplicated) 1745 5453 32285.675330 $1746284.7800 $54.0900
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Total 6948 33987.163010 $1810942.3500 $53.2800
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Number of Children (Unduplicated) With at Least One Authorization 1829