Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 13041 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
CASE -CASE NON-TCM CASE MANAGEMENT 4 4 13.533333 $500.7300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 158 186 602.775389 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 6.663492 $246.5500 $37.0000
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Subtotal (Total Children Is Unduplicated) 165 194 622.972214 $747.2800 $1.2000
Screening, Eval, and Assessment, Class # 02
AACRS -92597GN AAC RE-EVAL BY LICENSED SLP 1 1 1.000000 $52.6300 $52.6300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 62 77 98.698368 $4786.8600 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 3.000000 $70.5000 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 2.000000 $47.0000 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 3.000000 $43.7400 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.000000 $47.0000 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 4.000000 $39.1600 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 3.000000 $86.1600 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $89.5200 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 10 10 8.345205 $708.0100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.000000 $27.4200 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 6.005479 $125.4500 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 8 7.054795 $317.4700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.246575 $143.3600 $115.0000
EXIT -EXIT EXIT ASSESSMENT 35 35 70.000000 $3500.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 12 24.000000 $1800.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 16.000000 $1200.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 8 16.000000 $1200.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 18 36.000000 $1998.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 234 236 477.142857 $35785.7100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 37 37 73.000000 $5475.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 136 137 268.500000 $20137.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 11 11 20.000000 $1500.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 16 16 31.500000 $2362.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 474 478 943.642857 $52372.1800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 38 38 71.500000 $3968.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 238 255 488.928571 $36669.6500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 35 35 68.500000 $5137.5000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 4.000000 $204.2000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 12 16.857143 $860.5600 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 5.000000 $255.2500 $51.0500
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 10 10.000000 $510.5000 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 6 22.244618 $333.6700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 4.000000 $204.2000 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.084932 $4.3300 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 20 20 20.068493 $1024.5000 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 2.556165 $130.5000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 15.285714 $680.9800 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 0.221918 $9.8900 $44.5700
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 15 15 79.622222 $4185.7400 $52.5700
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Subtotal (Total Children Is Unduplicated) 820 1566 2966.005912 $190564.1000 $64.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 53 63 89.203848 $446020.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 3.500000 $175.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 25 34.066928 $1703.3500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 5 16.403262 $1129.5200 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 37 39 43.778864 $10069.1500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 345 383 459.689497 $22984.4700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 16 29 1.613703 $80.6700 $49.9900
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 54 55 62.034770 $1550.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 322 419 894.526985 $44726.3500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 37 46 98.015873 $4900.7900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 8 20.366666 $509.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 127 150 288.623008 $14431.1200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 13 15 30.544444 $1527.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 22.252380 $556.3100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 142 173 386.276189 $19313.8100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 19 23 39.999999 $2000.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 8 18.766665 $469.1600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 243 309 666.704763 $33335.2500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 26 33 52.544444 $2627.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 15 43.966666 $1099.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 22 22 27.180949 $1359.0700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1683 2202 16856.004760 $842799.4200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 83 104 704.871430 $35243.5300 $50.0000
INTR -T1013 INTERPRETER 151 184 696.638095 $34831.9100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1944 3165 22586.688678 $225866.6900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 74 94 655.314288 $46815.6300 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 6 7 66.980954 $4785.1100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 150 191 1499.095253 $107095.2200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 4 34.714285 $2479.9900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.733333 $213.4000 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 20 26 254.647620 $18191.9900 $71.4400
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.493150 $56.2200 $114.0100
SENS -V5060 BEHIND EAR HEARING AID 1 2 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 5 5.000000 $2280.0000 $456.0000
SENS -V5264 EARMOLD 11 14 27.499153 $494.9900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 191 230 1921.661901 $137283.4500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 8 89.285715 $6378.5700 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 4 5 27.428571 $1959.5000 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 26 32 262.428571 $18747.8700 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 10 13 113.142858 $1570.4200 $13.8800
TRAV -TRAVS Travel by mile 1946 3164 22512.074392 $10017.8500 $0.4400
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Subtotal (Total Children Is Unduplicated) 2060 11281 71619.762910 $2108135.8700 $29.4400
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Total 13041 75208.741036 $2299447.2500 $30.5700
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Number of Children (Unduplicated) With at Least One Authorization 2306