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 9993 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 154 168 314.973013 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.377778 $14.0500 $37.2000
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Subtotal (Total Children Is Unduplicated) 155 169 315.350791 $14.0500 $0.0400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 60 70 79.032813 $3833.1100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 6.066667 $340.3400 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.5100 $19.5100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $21.0400 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.000000 $86.9400 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 1.000000 $50.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 4 4 3.016667 $150.8400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 13 14 25.785714 $1933.9300 $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 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 15 15 28.285714 $2121.4300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 35 35 70.000000 $3885.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 12 12 27.133333 $1505.9000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 36 43 84.000000 $6300.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 17 22 43.000000 $3225.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.112329 $5.7700 $51.4000
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 8 8 8.000000 $411.2800 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $189.0300 $52.9300
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Subtotal (Total Children Is Unduplicated) 165 256 417.004666 $26438.5400 $63.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 10 12.611612 $63058.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 2.252055 $112.6100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 379 433 490.286495 $24514.3100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 25 33 6.109596 $305.4600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 54 55 152.246317 $3806.1600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 372 476 1085.938903 $54297.0100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 40 50 119.561116 $5978.0800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 15 17 32.509524 $812.7400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 121 147 367.480961 $18374.1100 $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 156 195 441.485479 $22074.3500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 26 32 66.033337 $3301.6900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 5 13.800000 $345.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 281 358 879.299213 $43964.9900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 30 39 73.705557 $3685.2900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 15 16 39.033334 $975.8400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 95 107 942.599996 $47130.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 163 186 1528.857147 $76442.8800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 24 185.400000 $9270.0200 $50.0000
INTR -T1013 INTERPRETER 164 196 713.378572 $35668.9600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2206 3516 27258.885240 $272589.0400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 12 13 117.657143 $8466.6100 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 2 6.066667 $436.5600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 16.209524 $1166.4400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 23 29 180.347619 $12977.8100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 16.857143 $1213.0400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 13.142857 $756.5100 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 10.428571 $750.4400 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 30 31 294.709524 $21207.3200 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 16.285715 $1171.9200 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $945.7600 $71.9600
TRAV -TRAVS Travel by mile 2218 3555 27473.463809 $12225.7100 $0.4500
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Subtotal (Total Children Is Unduplicated) 2303 9568 62623.585885 $751050.3000 $11.9900
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Total 9993 63355.941342 $777502.8900 $12.2700
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Number of Children (Unduplicated) With at Least One Authorization 2439