Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 4549 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 87 96 54.153961 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 87 96 54.153961 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 3 8.061111 $390.9600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 9 6.616667 $371.2000 $56.1000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.266666 $12.0800 $45.3100
OCTH -97165 OT EVAL LOW COMPLEXITY 53 55 31.415076 $1615.0400 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 30 34 9.755555 $501.5300 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.194444 $9.9900 $51.4000
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 5 5 2.255555 $115.9600 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 54 59 58.096823 $2986.7500 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.211111 $10.8500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 8 9 1.961111 $100.8200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 27 28 10.911110 $560.9400 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 17 20 5.238887 $269.3200 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 44 49 36.477774 $1875.3000 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 4 5 1.088889 $55.9800 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 41 46 37.599997 $1933.0000 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 35 43 22.135715 $1138.0000 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.483333 $24.8500 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 33 36 11.444443 $588.3500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 0.900000 $46.2700 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 16 16 14.338888 $643.2400 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.455556 $20.4400 $44.8600
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Subtotal (Total Children Is Unduplicated) 252 429 260.419822 $13297.1400 $51.0600
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 2.027778 $469.6800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 53 154 42.961509 $2148.0800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 8 6.588889 $329.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 4 2.977777 $74.4400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 16 17 39.313491 $1965.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 5.177778 $129.4500 $25.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.044444 $1.1100 $24.9800
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 6 7.400000 $370.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 0.266667 $6.6700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 22 29 243.142855 $6078.5800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 149 211 1624.214286 $40605.4100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 9 96.428570 $4821.4400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 2.285714 $114.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 870 1044 9485.603164 $474280.5100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 394 445 3359.536503 $167976.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1231 1504 13069.988072 $130699.9800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 101 107 941.499997 $67750.4000 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 20 21 139.481351 $8034.1200 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 76 85 500.257547 $35998.4900 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 4.428571 $318.6800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 72 76 655.500001 $47169.8400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 20 24 158.214289 $9106.8000 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 45 52 286.785721 $20637.0600 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 12.857143 $925.2000 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 3 3 3.000000 $54.3900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 93 97 753.357149 $54211.5900 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 73 87 528.714291 $38046.2400 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 11.000000 $791.5600 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 14 18 93.785715 $1309.2500 $13.9600
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Subtotal (Total Children Is Unduplicated) 1498 4024 32094.982129 $1116294.0500 $34.7800
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Total 4549 32409.555912 $1129591.2000 $34.8500
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Number of Children (Unduplicated) With at Least One Authorization 1567