Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 3300 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 6 7 4.822221 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 6 7 4.822221 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 6 10.477779 $152.7700 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 2 3.066667 $72.0700 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 6 10.477779 $102.5800 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 6 10.477779 $300.9300 $28.7200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $13.7100 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 6 10.477779 $218.8800 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 5 0.802740 $36.1200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 1.284932 $147.7800 $115.0100
EXIT -EXIT EXIT ASSESSMENT 4 4 4.000000 $200.0000 $50.0000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 29 30 31.833333 $1625.0900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 10 10 10.000000 $510.5000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 28 30 30.000000 $1531.5000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 93 94 94.000000 $4700.0000 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 6.000000 $306.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 20 21 21.000000 $1072.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 19 19 21.066667 $938.5200 $44.5500
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Subtotal (Total Children Is Unduplicated) 186 252 266.965455 $11979.8400 $44.8700
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 5 12.000001 $600.0100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 1.866667 $93.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 466 614 1683.402373 $84170.0800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 298 407 1200.733326 $60036.6300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 6.133333 $153.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 139 180 510.538094 $25526.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 370 459 1214.038098 $60701.9200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 3.066667 $153.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 5 8.300000 $207.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 528 657 4050.944038 $202547.3700 $50.0000
INTR -T1013 INTERPRETER 13 15 138.076189 $6903.8200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 91 114 474.259528 $33881.1200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.066667 $219.0900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 33 38 225.261905 $12884.9900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 5 6 37.095238 $2121.8500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 83 103 579.897616 $41427.9100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.100000 $150.0200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 5 14.428572 $824.7300 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 5.678571 $324.5900 $57.1600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 2.277778 $519.3400 $228.0000
SENS -V5264 EARMOLD 4 5 5.211112 $93.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 314 414 2543.461903 $181705.0200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 7.000000 $500.0800 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 4 4 23.452382 $325.5200 $13.8800
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Subtotal (Total Children Is Unduplicated) 847 3041 12752.290058 $716072.2700 $56.1500
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Total 3300 13024.077734 $728052.1100 $55.9000
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Number of Children (Unduplicated) With at Least One Authorization 859