Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 2989 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 10 11 6.799999 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 11 6.799999 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 6.666668 $97.8700 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 6.666668 $48.0000 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 6.666668 $192.8000 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 6.666668 $140.2700 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 0.561644 $25.4600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 2.534247 $293.5000 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.000000 $100.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 13 15 15.000000 $771.1500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 19 20 19.400000 $997.3500 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 6 6 6.000000 $308.4600 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 8 8 8.000000 $411.2800 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 13 13 13.000000 $668.3300 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 91 96 98.366667 $4918.3400 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 24 25 25.000000 $1285.2500 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.8200 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 11 11 13.066667 $671.7600 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 4 4.000000 $205.6400 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 9 10 9.433333 $484.9700 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.7200 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 4 25.857143 $1368.6200 $52.9300
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Subtotal (Total Children Is Unduplicated) 182 250 280.886373 $13592.8600 $48.3900
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 6.133334 $306.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 11.333333 $566.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 409 587 1673.240476 $83662.0200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 7.666666 $383.3300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 257 347 1115.490474 $55774.5100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 148 212 742.566670 $37128.3500 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 272 331 973.800007 $48690.0400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 8.900000 $445.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 14 37.200001 $930.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.133333 $28.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 10 12 64.019048 $3200.9500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 514 659 4108.252358 $205412.6700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 3 3 10.166666 $508.3300 $50.0000
INTR -T1013 INTERPRETER 4 4 33.419047 $1670.9600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 90 409.514283 $29468.6600 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 5 7 30.342858 $2183.4800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 30 40 251.166665 $14467.2100 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 88 107 521.978574 $37561.5800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 7 8 35.600000 $2561.7800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 19 22 149.138095 $8584.3800 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 2 15.142857 $871.6300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 6.133333 $441.3500 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 2.858333 $205.6800 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 9.714286 $559.1600 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 2.100000 $120.8800 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 4.000000 $918.4400 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 4 4 2.222222 $40.2900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 200 246 1341.732138 $96551.0700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 13 13 101.209521 $7283.0400 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 6.133333 $441.3500 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 1.033333 $14.4200 $13.9600
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Subtotal (Total Children Is Unduplicated) 782 2728 11684.341244 $641441.4300 $54.9000
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Total 2989 11972.027616 $655034.2900 $54.7100
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Number of Children (Unduplicated) With at Least One Authorization 805