Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 2949 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 96 101 5116.742855 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 21 21 7936.000000 $295219.2000 $37.2000
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Subtotal (Total Children Is Unduplicated) 117 122 13052.742855 $295219.2000 $22.6200
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 3.066667 $59.8300 $19.5100
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 2.044444 $92.6500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 39 47 58.336911 $2916.8500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 9 10 14.723288 $736.1700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 15 15 28.000000 $1400.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.022222 $76.6700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 28 29 58.000000 $4350.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 10 10 20.000000 $1500.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 10 11 22.000000 $1650.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 25 25 50.000000 $2775.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $777.0000 $55.5000
OCTF -97168 OT RE-EVAL EST PLAN CARE 14 14 4.433333 $227.9200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 1.233333 $63.4000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 24 25 13.718949 $705.2900 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.411111 $21.1300 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 13 6.116667 $314.4600 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 10.142857 $521.4500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.077778 $4.0000 $51.4200
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 7 5.511112 $283.3300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 3.816667 $196.2200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 24 28 9.760317 $501.7700 $51.4100
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Subtotal (Total Children Is Unduplicated) 182 269 351.926767 $21115.2100 $60.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 4 1.811111 $9055.5000 $4999.9700
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 0.555556 $27.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 4.066667 $941.9300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 26 32 22.044445 $1102.2300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 9 15.050000 $376.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 351 447 352.066650 $17603.2500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 4 4 2.244444 $112.2200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 190 243 382.370636 $9559.2700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 183 408 259.248787 $12962.3300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 6 3.688888 $184.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 85 196 235.683323 $5892.0600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 78 194 116.211098 $5810.4900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 37 97 126.011109 $3150.2700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 315 381 306.575380 $15328.6900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 1.188889 $59.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 180 219 319.294447 $7982.3700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 27.571428 $1378.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 114 144 1222.066658 $61103.4200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 6 56.285714 $2814.2900 $50.0000
INTR -T1013 INTERPRETER 1 1 2.500000 $125.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 24 27 206.238095 $14840.9100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 12.285714 $884.0800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 26 31 367.285714 $21155.6700 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 19 26 231.285711 $16643.3600 $71.9600
PHY -97110HM PT SESSION BY PT ASST 11 12 127.142857 $7318.3500 $57.5600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 2 6.571428 $378.2600 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.022223 $234.7300 $229.6300
SENS -V5060 BEHIND EAR HEARING AID 2 2 3.044444 $699.0200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.116667 $53.5900 $459.3500
SENS -V5264 EARMOLD 2 3 5.111111 $92.6600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 43 49 414.000000 $29791.4500 $71.9600
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Subtotal (Total Children Is Unduplicated) 573 2558 4830.639194 $247661.8600 $51.2700
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Total 2949 18235.308816 $563996.2700 $30.9300
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Number of Children (Unduplicated) With at Least One Authorization 715