Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 7059 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 53 59 49.633335 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 53 59 49.633335 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 25 25 32.714286 $1822.5100 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 37 40 51.053175 $1199.7500 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 43 44 47.588889 $1118.3400 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 33 34 34.755556 $506.7400 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 38 39 37.677779 $885.4300 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 67 74 59.220634 $579.7700 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 26 26 26.000000 $254.5400 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 82 90 68.631746 $1971.1100 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 33 34 35.144445 $1573.0700 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 6.000000 $509.0400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 5 5 5.000000 $255.3500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 116 129 110.726190 $1518.0600 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 96 102 140.073016 $2926.1300 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 13 12.433333 $559.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.0000 $115.0000
EXIT -EXIT EXIT ASSESSMENT 64 64 101.476191 $5073.8200 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 25 25 50.000000 $2775.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 23 23 46.000000 $3450.0000 $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 22 27 25.483334 $1300.9300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 4.394444 $224.3300 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 12.857143 $656.3600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 18 19 7.738890 $395.0800 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.061111 $3.1200 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 91 103 97.476736 $4976.2000 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.500000 $25.5300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 15 19 19.500000 $995.4800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 4.000000 $204.2000 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.022222 $1.1300 $51.0000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 13 17 12.233333 $624.5100 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 58 70 61.253969 $3127.0200 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 20 20 13.044443 $665.9100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 20 21 20.022222 $1022.1300 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.1000 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 1.022222 $52.1800 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 3 3 1.283333 $65.5100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 154 177 131.653305 $6720.9100 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.500000 $178.6800 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 3.688889 $188.3200 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 5 5.000000 $255.2500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 8 8 7.500000 $382.8800 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 52 61 59.496826 $2650.5900 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.500000 $111.3800 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 13 15 72.999999 $3837.6200 $52.5700
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Subtotal (Total Children Is Unduplicated) 704 1377 1444.727661 $56418.8500 $39.0500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 1.866667 $9333.5000 $5000.0900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 13 15 24.269842 $1213.5000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 7.714286 $531.2100 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 34 39 74.173017 $5107.5500 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 26 27 38.611111 $8880.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 312 425 289.514727 $14475.8800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 4 5 6.500000 $325.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 19 24 24.960316 $624.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 820 1105 2914.279557 $145714.0000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 3 4 13.933333 $696.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 6 16.499999 $412.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 420 514 1182.475003 $59123.7700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 9 10 20.966668 $524.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 160 206 473.557611 $23677.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 4.566667 $114.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 449 557 1205.561895 $60278.0600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 3 9.428571 $471.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 9 10.066667 $251.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 17 17 65.180952 $3259.0500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1509 1963 17901.606788 $895079.5900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 21 21 84.000001 $4200.0000 $50.0000
INTR -T1013 INTERPRETER 1 1 3.000000 $150.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 112 138 1163.214293 $83099.9500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 5 6 60.285714 $4306.8100 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 16.571429 $1183.8600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 84 113 953.038094 $68085.0000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 4 36.428571 $2602.4700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 0.571429 $32.6600 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 2 25.714286 $1837.0300 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.688889 $314.1400 $456.0100
SENS -V5264 EARMOLD 3 3 2.838889 $51.1000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 287 364 3064.552382 $218931.4800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 7 75.000000 $5357.9900 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 35.285714 $2520.8100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 7 9 64.095239 $4578.9500 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 10 12 101.571426 $1409.8100 $13.8800
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Subtotal (Total Children Is Unduplicated) 1724 5623 29972.590033 $1628756.2000 $54.3400
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Total 7059 31466.951029 $1685175.0500 $53.5500
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Number of Children (Unduplicated) With at Least One Authorization 1785