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 3623 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
----------------------------------------------------------------------------
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 7 7 8.000000 $445.6800 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.911111 $44.9100 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 6 6 7.911111 $185.9100 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $29.1600 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 2.911111 $68.4100 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 10 10 4.727777 $46.2800 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 2.000000 $19.5800 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 11 11 6.333333 $181.8900 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.911111 $85.5400 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 13 13 9.333333 $127.9600 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 14.196825 $296.5700 $20.8900
EXIT -EXIT EXIT ASSESSMENT 106 106 188.034738 $9401.7400 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 6 6 8.032876 $445.8200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 4 1.227778 $62.6800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 11 13 11.233333 $573.4600 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.222222 $11.3400 $51.0400
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.288889 $65.8000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 7 3.033334 $154.8600 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.411111 $72.0400 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.1000 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 0.711111 $36.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 16 16 11.766667 $600.6900 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.194444 $9.9200 $51.0400
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 7 5.511111 $245.5200 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 171 240 305.903326 $13954.2800 $45.6200
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 6 13.742857 $687.1500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 9 10.577778 $728.3900 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 4 5 9.000000 $2070.0000 $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 391 477 1218.913135 $60945.8500 $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 448 542 1306.961954 $65348.3200 $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 440 555 5327.415843 $266371.0700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 6.142857 $307.1500 $50.0000
INTR -T1013 INTERPRETER 1 1 1.000000 $50.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 7 8 71.285714 $5092.6600 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 6.571429 $469.4600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 9 12 109.714284 $7838.0000 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 28 31 275.423013 $19676.2600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.857143 $418.4300 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $938.9300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 4 32.285714 $2306.5000 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 25.571428 $354.9300 $13.8800
TRAV -TRAVS Travel by mile 1 1 13.142857 $5.8500 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1142 3326 12501.399192 $634370.5000 $50.7400
-------------------------------------------------------------------------------------------------------------------------------------
Total 3623 12899.996169 $648324.7800 $50.2600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1215