Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 4670 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 104 110 100.784132 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 104 110 100.784132 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 5 1.438889 $69.7900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.000000 $111.4200 $55.7100
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.583333 $26.2500 $45.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 8 8 1.255555 $64.0900 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 3 0.788889 $40.2700 $51.0500
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 2.803968 $143.1400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 115 141 119.480954 $6099.5200 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.166667 $8.5100 $51.0600
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 0.622221 $31.7600 $51.0400
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.322222 $16.4500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 1.350001 $68.9200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 89 115 65.647622 $3351.3200 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.366667 $18.7200 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 8 8 1.516666 $77.4200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 41 56 16.177779 $825.8800 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.366667 $18.7200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.105556 $5.3900 $51.0700
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 69 84 83.494446 $3719.6800 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 4.142857 $217.7900 $52.5700
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Subtotal (Total Children Is Unduplicated) 261 444 302.792070 $14923.2700 $49.2900
EI Services, Class # 03
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 2 2.000000 $100.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 12.285714 $845.9900 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 2 4 3.022222 $695.1100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 50 154 120.531751 $6026.5900 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5 6 2.777777 $138.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.711111 $42.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4 5 1.833333 $91.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 10.045237 $251.1300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1 1 0.511111 $25.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2 2 0.677778 $33.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 15.434921 $385.8700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 20.714285 $517.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 150 194 1557.857150 $38946.3800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 7 35.428571 $1771.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1201 1508 13041.204770 $652059.4900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 64 66 253.142851 $12657.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1257 1571 13272.831755 $132728.1600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 89 112 800.500004 $57187.6100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 87 105 770.249996 $44058.2400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 67 92 714.342064 $51032.5500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.785714 $341.8900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 59 74 529.857144 $30286.5900 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 12.857143 $734.9100 $57.1600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.000000 $912.0000 $456.0000
SENS -V5264 EARMOLD 2 3 1.500000 $27.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 97 137 867.980162 $62008.4400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 19.285714 $1103.1400 $57.2000
SPL -92508HA GROUP SPL SESSION PER CHILD 41 45 395.214283 $5485.5700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1527 4116 32471.582561 $1100545.8700 $33.8900
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Total 4670 32875.158763 $1115469.1400 $33.9300
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Number of Children (Unduplicated) With at Least One Authorization 1605