Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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: 07-01-21 and 06-30-22 Date of Report: 08-08-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5088 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 1 1 0.250000 $9.2500 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 56 63 105.519843 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.833333 $67.8300 $37.0000
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Subtotal (Total Children Is Unduplicated) 58 65 107.603176 $77.0800 $0.7200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 24 30 36.123016 $1751.9700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 5 5.000000 $278.5500 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 12 12 10.500000 $246.7500 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 2.011111 $47.2600 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 11 11 5.211111 $75.9800 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 257 280 272.874604 $6412.5600 $23.5000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 0.250000 $21.2100 $84.8400
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 7 6.183333 $278.2500 $45.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $55.5000 $55.5000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 11.142857 $568.8500 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 2.000000 $102.1000 $51.0500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 4 19.304762 $1014.8500 $52.5700
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Subtotal (Total Children Is Unduplicated) 312 355 371.600794 $10853.8200 $29.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 21 28 26.465873 $132329.0000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 30.428571 $1521.4300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.966667 $66.5700 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 38 41 38.938889 $8955.9500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 33 28.283333 $1414.1700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 31 37 67.557936 $3377.9000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 4.500000 $112.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 13 13 38.066667 $1903.3400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 20 24 89.978571 $4498.9400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 3 3 2.844444 $71.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 92 113 239.436505 $11971.8200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 119 145 327.503967 $16375.1900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 24 25 50.041271 $1251.0400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 53 68 180.003178 $9000.1800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 53 66 228.823017 $11441.1500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.900000 $72.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 65 74 138.955555 $6947.7800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 72 79 176.671430 $8833.5900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 17 18 24.205556 $605.1400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 25 27 766.961901 $38348.0900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 533 658 6504.862669 $325243.1800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 770 1160 13488.096793 $674404.8700 $50.0000
INTR -T1013 INTERPRETER 2 2 11.433333 $571.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 632 1013 7306.660260 $73066.6200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 58 74 716.213491 $51166.3200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 28 38 335.233331 $23949.0500 $71.4400
OCCT -97530TL OT SESSION BY LICENSED OT 50 70 579.976185 $41433.5100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 106 141 1409.865871 $100720.8600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 39 61 622.661901 $44482.9500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 13 16 114.488888 $8179.0900 $71.4400
PHY -97110TL PT SESSION BY LICENSED PT 47 63 479.223804 $34235.7600 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 76 91 695.438095 $49682.0900 $71.4400
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.722222 $329.3200 $455.9900
SENS -V5264 EARMOLD 5 10 18.800000 $338.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 91 129 1121.547610 $80123.4000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 42 59 683.128571 $48802.7300 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 58 80 798.817459 $57067.5500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 145 192 2370.916664 $169378.2800 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 2.166667 $30.0700 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 3 23.866666 $331.2700 $13.8800
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Subtotal (Total Children Is Unduplicated) 1547 4668 39747.653811 $2042634.3100 $51.3900
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Total 5088 40226.857781 $2053565.2100 $51.0500
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Number of Children (Unduplicated) With at Least One Authorization 1577