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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 14492 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 186 204 471.305555 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 5.444445 $202.5400 $37.2000
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Subtotal (Total Children Is Unduplicated) 189 207 476.750000 $202.5400 $0.4200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 74 88 102.710591 $4981.4800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 22 23 32.331378 $1813.7900 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 13 15 34.714286 $677.2700 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 6 16.857143 $399.0100 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 7 17.857143 $262.1400 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 7 17.857143 $394.1100 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 6 16.857143 $121.3700 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 2.466667 $25.7800 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 6 16.857143 $487.5100 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 6 16.857143 $759.9200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 6 16.857143 $232.8000 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 17 19 53.740118 $1130.6900 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 3 3 3.000000 $260.8200 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 1.000000 $75.1300 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 3.504110 $158.8100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 12.184736 $1411.1300 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 6 6 5.016667 $250.8400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 13 26.000000 $1950.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $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 7 12 24.000000 $1800.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 9 18.000000 $999.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 85 88 169.285714 $12696.4300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 36 37 72.500000 $5437.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 44.000000 $3300.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 11 11 22.000000 $1650.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 59 59 113.785714 $8533.9300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 12 12 24.000000 $1800.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 282 286 563.500000 $31274.2500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 91 92 183.704762 $10195.6100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 351 468 925.566667 $69417.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 120 152 300.071429 $22505.3600 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 17 18 19.000000 $976.7900 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 2.000000 $102.8200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.145206 $7.4600 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 7 8.515983 $128.6800 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 17 18 18.000000 $925.3800 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 6.947554 $357.1700 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.079452 $55.5000 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 12 15 139.647620 $7391.5400 $52.9300
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Subtotal (Total Children Is Unduplicated) 805 1573 3091.418655 $197321.9800 $63.8300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 62 66 89.535641 $447679.0000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 12 12 13.236987 $661.8500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 13.142857 $911.4600 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 23 27 45.075538 $10440.4100 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 387 443 500.119828 $25005.9800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 26 34 8.109596 $405.4600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 55 56 152.479650 $3811.9900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 374 478 1087.038903 $54352.0100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 40 50 119.561116 $5978.0800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 17 19 34.009524 $850.2400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 122 149 370.314295 $18515.7800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 14 18 34.166667 $1708.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 8 15.633335 $390.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 159 198 450.885479 $22544.3500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 26 32 66.033337 $3301.6900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 8 19.600001 $490.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 285 362 890.465880 $44523.3300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 30 39 73.705557 $3685.2900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 17 18 43.366668 $1084.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 248 305 2460.395227 $123019.8700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1669 2111 17434.176162 $871709.3300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 215 275 2032.038091 $101601.9700 $50.0000
INTR -T1013 INTERPRETER 181 216 765.119048 $38255.9800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2208 3518 27298.313811 $272983.3300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 72 91 633.314283 $45573.3200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 33.142857 $2384.9600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 3 4 8.352381 $601.0500 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 16.209524 $1166.4400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 186 243 1918.495230 $138055.0300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 6 6 67.285714 $4841.8900 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 13.142857 $756.5100 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 17.857142 $1285.0000 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 9 10 84.461904 $6077.8800 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 7 3.474887 $398.9600 $114.8100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 10 12 12.470319 $226.0900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 236 287 2487.247611 $178982.4400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 26 30 230.946033 $16618.8700 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 10 14 141.999998 $10218.3400 $71.9600
TRAV -TRAVS Travel by mile 2218 3555 27473.463809 $12225.7100 $0.4500
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Subtotal (Total Children Is Unduplicated) 2344 12712 87160.387747 $2474241.6400 $28.3900
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Total 14492 90728.556402 $2671766.1500 $29.4500
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Number of Children (Unduplicated) With at Least One Authorization 2590