Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 4463 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
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 49 62 35.624733 $1727.8100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 4 2.260274 $126.8000 $56.1000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 9 10 6.709589 $98.5000 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.008219 $22.2500 $22.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 1.022223 $46.3300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.252055 $29.2000 $115.8300
EXIT -EXIT EXIT ASSESSMENT 27 27 30.002740 $1500.1400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 2.005479 $111.3100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 54 54 91.543832 $6865.8000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 28 29 55.500000 $4162.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 46.000000 $3450.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 63 66 114.543832 $6357.1900 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 22 22 41.500000 $2303.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 10 12 23.000000 $1725.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 16.000000 $1200.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 2 3.066666 $153.3300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.666667 $34.2800 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 23 28 33.886692 $1742.1100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 23 27 11.316211 $581.7700 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 0.419178 $21.5500 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.252055 $12.9600 $51.4200
OCTH -97167 OT EVAL HIGH COMPLEXITY 17 20 8.115372 $417.2100 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 2 0.511111 $26.2800 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 3 0.616668 $31.7100 $51.4200
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 7.285714 $374.5600 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 3 1.022222 $52.5500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 20 26 11.012100 $566.1300 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.202740 $10.4200 $51.4000
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 23 28 13.807992 $709.8800 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 5 5 1.005480 $51.7000 $51.4200
PSTH -97163 PT EVAL HIGH COMPLEXITY 23 24 6.290183 $323.3900 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.126027 $6.4800 $51.4000
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 3 0.727549 $37.4000 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 17 19 10.910121 $560.8800 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 6 8 4.064078 $208.9300 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 46 52 27.855241 $1432.0400 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 1.466667 $75.4000 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 0.511111 $26.2800 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.401141 $20.6200 $51.4000
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.366667 $18.8500 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 6 2.355556 $105.6700 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.511111 $22.9300 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 21.285714 $1126.6600 $52.9300
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Subtotal (Total Children Is Unduplicated) 265 612 658.036489 $39990.8500 $60.7700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 56 74 113.039922 $565200.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 1.085388 $54.2700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.180822 $12.5400 $69.3400
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 2.203045 $510.2800 $231.6300
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 31 35 54.405265 $2720.2700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 4.500000 $225.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 6.133334 $153.3400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 325 453 936.561938 $46828.2700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 2.633333 $131.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 153 197 399.413976 $19970.7800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 2.000000 $100.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.133334 $153.3400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 35 45 84.092859 $4204.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 293 373 733.190507 $36659.6700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 3 5.066667 $253.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 5 12.000000 $300.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 10 11 79.857144 $3992.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 292 373 3020.438091 $151022.0500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 44 51 412.714281 $20635.7400 $50.0000
INTR -T1013 INTERPRETER 21 36 126.255480 $6312.7700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 358 901 4709.076937 $47090.8400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 81 99 871.685710 $62726.6100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 3 20.428571 $1470.0400 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 2 13.142857 $757.0300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 80 106 906.857138 $65257.5200 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 13.142857 $756.5100 $57.5600
SENS -V5060 BEHIND EAR HEARING AID 2 3 2.504110 $574.9700 $229.6100
SENS -V5264 EARMOLD 2 3 2.756164 $49.9700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 84 99 850.357141 $61191.7900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 14.285714 $1028.0100 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 2 13.142857 $183.4700 $13.9600
TRAV -TRAVS Travel by mile 361 956 246143.301475 $109533.7700 $0.4500
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Subtotal (Total Children Is Unduplicated) 416 3851 259562.586917 $1210061.8400 $4.6600
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Total 4463 260220.623406 $1250052.6900 $4.8000
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Number of Children (Unduplicated) With at Least One Authorization 438