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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5811 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 37 42 2822.633332 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 146 172 20270.982538 $750026.3500 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 179 214 23093.615870 $750026.3500 $32.4800
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 2.000000 $90.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 5 3.788888 $435.7100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 36 38 48.729755 $2436.4900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 6.011111 $300.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 81 81 147.355555 $7367.7800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 9 9 18.000000 $1350.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 8.005479 $600.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 2.005479 $111.3100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 6 12.000000 $666.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 35 35 70.000000 $5250.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 208 209 416.285714 $31221.4300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 22 22 44.000000 $3300.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 41 42 80.209524 $6015.7200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 87 90 178.285714 $13371.4300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 27 27 54.000000 $2997.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 96 96 192.000000 $10656.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 13 18 36.000000 $2700.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 111 141 69.662694 $3556.2700 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 4 4 2.444444 $124.7900 $51.0500
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 1 1 0.188889 $9.6400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.005556 $0.2900 $51.4600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 24 24 15.177779 $774.8300 $51.0500
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 136 155 100.617076 $5136.4900 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 1.511111 $77.1400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 55 67 23.161113 $1182.3900 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.0900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 10 11 5.866666 $299.4900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 53 61 35.088888 $1791.2800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 0.750000 $38.2900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 230 275 109.557934 $5592.9300 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 9 12 3.749999 $191.4300 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.911111 $46.5100 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $26.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 1.305556 $58.1600 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 780 1468 1709.870479 $109310.7200 $63.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 3.983333 $19916.5000 $4999.9600
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 3.200000 $160.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 6 3.711111 $185.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 5.288889 $1216.4500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 5 7 19.165079 $958.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 11 6.655558 $166.4000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 317 413 323.664281 $16183.1900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 1.288889 $64.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 279 359 444.376191 $11109.4100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 199 437 282.824590 $14141.1700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 0.188889 $9.4500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 124 265 282.911109 $7072.7700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 54 134 106.615868 $5330.7700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 48 119 142.388888 $3559.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 276 341 270.877774 $13543.8700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 0.388889 $19.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 265 332 382.627783 $9565.7100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 7 68.857142 $1721.4400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 406 519 4462.138050 $223107.2800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 26 140.285714 $7014.3000 $50.0000
INTR -T1013 INTERPRETER 2 2 3.000000 $150.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 197 246 1774.119030 $126743.2300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 18.571428 $1326.7500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 201 266 2500.299987 $143017.2800 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 8 9 75.428572 $4314.5200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 84 105 846.923799 $60504.3200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 13.142857 $938.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 72 98 961.142854 $54938.9400 $57.1600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 6.428571 $367.4600 $57.1600
SENS -V5060 BEHIND EAR HEARING AID 3 4 4.460274 $1016.9500 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 4 6.088888 $2776.4900 $455.9900
SENS -V5264 EARMOLD 9 11 10.055554 $181.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 286 363 3074.816633 $219665.2300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 37.642856 $2689.2100 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 13 15 160.642856 $11476.3400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 26.285714 $1877.8600 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 3.066667 $42.5700 $13.8800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 904 4129 16473.554567 $967073.1700 $58.7000
-------------------------------------------------------------------------------------------------------------------------------------
Total 5811 41277.040916 $1826410.2300 $44.2500
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1122