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 8793 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 3 3 4.533333 $167.7300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 130 150 307.236503 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.211111 $7.8100 $37.0000
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Subtotal (Total Children Is Unduplicated) 133 154 311.980947 $175.5400 $0.5600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 55 69 91.951793 $4459.6500 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $23.5000 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.5000 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $14.5800 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.5000 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.000000 $9.7900 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $28.7200 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $44.7600 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.098630 $8.3700 $84.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $13.7100 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $20.8900 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.054795 $2.4700 $45.0000
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 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 -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 16 16 32.000000 $2400.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 17 17 34.000000 $2550.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 54 54 108.000000 $5994.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 5.000000 $277.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 28 32 63.000000 $4725.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 4.000000 $204.2000 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 3.000000 $153.1500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 10.285714 $458.2300 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 7.638096 $401.5300 $52.5700
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Subtotal (Total Children Is Unduplicated) 165 267 475.029028 $27931.7500 $58.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 9 6.669406 $33347.5000 $5000.0700
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.312329 $21.5100 $68.8500
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 4.000000 $920.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 334 371 447.189497 $22359.4700 $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 50 51 53.034770 $1325.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 321 418 893.526985 $44676.3500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 37 46 98.015873 $4900.7900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 6 15.133333 $378.3300 $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 5 5 19.252380 $481.3100 $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 5 5 11.933332 $298.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 237 302 652.038097 $32601.9200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 26 33 52.544444 $2627.2200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 13 38.333333 $958.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 14.752379 $737.6300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 132 156 1344.252387 $67212.6000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 6.999999 $350.0000 $50.0000
INTR -T1013 INTERPRETER 126 148 611.138095 $30556.9100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1943 3162 22561.831535 $225618.1200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 13 14 82.228573 $5874.4000 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 3 30.409525 $2172.4500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 16 18 162.123812 $11582.1100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 3.733333 $213.4000 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 2 12.571428 $898.1000 $71.4400
SENS -V5264 EARMOLD 1 1 0.109589 $1.9700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 34 39 339.023807 $24219.8500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 2 12.571428 $898.1000 $71.4400
TRAV -TRAVS Travel by mile 1945 3159 22449.788677 $9990.1400 $0.4400
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Subtotal (Total Children Is Unduplicated) 2020 8372 50671.575689 $562625.4900 $11.1000
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Total 8793 51458.585664 $590732.7800 $11.4800
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Number of Children (Unduplicated) With at Least One Authorization 2108