Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 3672 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 52 56 47.547614 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 52 56 47.547614 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 14 14 14.000000 $785.4000 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 9 9 32.000000 $624.3200 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 2.000000 $47.3400 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 3 3.000000 $44.0400 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 1.122222 $24.7700 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.450000 $3.2400 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.4500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 8 5.572222 $161.1500 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $45.0800 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 18 20 17.572222 $242.6700 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 7.000000 $147.2800 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.000000 $90.6400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.000000 $231.6200 $115.8100
EXIT -EXIT EXIT ASSESSMENT 16 16 20.000000 $1000.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 3 3.000000 $154.2300 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 8 9 6.405556 $329.3100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 4 1.338889 $68.8300 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 6 7 14.680953 $754.7500 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 3 3.000000 $154.2300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 7 9 5.533333 $284.4700 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 3 1.022222 $52.5500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 4 1.338889 $68.8300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 7 3.616667 $185.9300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 31 38 34.201590 $1758.3100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.511111 $26.2800 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 24 37.024603 $1903.4400 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 0.883333 $45.4100 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 2.511111 $129.1000 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 0.477778 $24.5600 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.511111 $67.7900 $44.8600
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Subtotal (Total Children Is Unduplicated) 150 219 241.773812 $10432.0300 $43.1500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 3.000000 $15000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 6 5.283333 $264.1700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 6.000000 $1389.7200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 225 317 215.113710 $10755.7900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 3 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 9 17.833334 $445.8400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 812 1090 2989.240497 $149462.1300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 2.833333 $141.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 2 3.066666 $76.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 398 501 1164.974637 $58248.9100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 0.433333 $21.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 3.266667 $81.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 183 240 681.328581 $34066.4800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.600000 $15.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 417 517 1151.900024 $57595.1200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 2 6.571429 $328.5700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 8.733333 $218.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 63 72 595.661900 $29783.1100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 0.928571 $46.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 344 426 3995.652758 $199782.7600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 48 51 426.990483 $21349.5200 $50.0000
INTR -T1013 INTERPRETER 2 2 28.819047 $1440.9500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 21 27 216.571430 $15584.4800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 17 25 187.171426 $13468.8800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 26.285714 $1513.0000 $57.5600
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 62 82 640.968253 $46124.1100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 5 33.857143 $2436.3600 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.285714 $16.4600 $57.6000
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Subtotal (Total Children Is Unduplicated) 1154 3397 12417.371316 $659845.2400 $53.1400
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Total 3672 12706.692742 $670277.2600 $52.7500
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Number of Children (Unduplicated) With at Least One Authorization 1215