Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 15376 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 151 170 303.665872 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 44.000000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.233333 $8.6800 $37.1900
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Subtotal (Total Children Is Unduplicated) 154 173 347.899205 $8.6800 $0.0200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 87 120 133.432789 $6471.4900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 39 43 84.918004 $4763.8900 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 10 10 25.752380 $407.9200 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 8 11 22.857143 $445.9400 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 7 10 22.857143 $541.0300 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 8 11 22.857143 $335.5400 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 8 29.390476 $648.6500 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 10 31.390476 $226.0100 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 3.000000 $31.3500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 8 29.390476 $849.9700 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 9 20.857143 $940.2400 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 7 18.857143 $260.4200 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 22 25 71.313894 $1500.4400 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 4 5 7.285714 $633.4200 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 2 2.000000 $150.2600 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 6 3.493152 $158.3100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 24.863795 $2879.4800 $115.8100
EXIT -EXIT EXIT ASSESSMENT 61 64 64.865362 $3243.2800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 12 21.000000 $1575.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 17 33.500000 $2512.5000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 18 35.500000 $1970.2500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 4 8.000000 $444.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 62 63 124.000000 $9300.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 34 35 70.000000 $5250.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 46 46 89.500000 $6712.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 12 13 25.000000 $1875.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 64 65 127.500000 $9562.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 23 24 48.000000 $3600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 334 337 662.642857 $36776.6800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 143 150 293.666667 $16298.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 365 479 922.320482 $69174.0500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 124 147 290.500000 $21787.5000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 17 18 20.000000 $1028.2000 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 3.000000 $154.2300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 5.000000 $257.0500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 1.304110 $67.0400 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 6 7.273972 $109.9100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 13 13 13.000000 $668.3300 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 7.214286 $370.8900 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.298631 $15.3500 $51.4000
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.224658 $99.8000 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 14 17 137.057143 $7254.4300 $52.9300
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 4.571429 $241.9600 $52.9300
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Subtotal (Total Children Is Unduplicated) 949 1871 3615.456468 $224657.4000 $62.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 79 103 123.065492 $615326.5000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.177626 $108.8900 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 12.857142 $891.6500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 20 24 37.166731 $8608.5500 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 442 510 586.276304 $29313.8100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 22 27 1.587676 $79.3500 $49.9800
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 75 83 183.908937 $4597.7200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 422 529 1197.213500 $59860.7000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 41 55 131.616667 $6580.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 22 25 43.455557 $1086.3900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 160 194 448.600796 $22430.0500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 16 19 37.435712 $1871.7800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 9 15.888889 $397.2200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 183 234 502.975399 $25148.7900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 22 28 53.433332 $2671.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 12 13 27.388890 $684.7300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 299 372 816.219849 $40811.0300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 30 40 77.661110 $3883.0500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 19 24 76.366668 $1909.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 219 250 2079.366676 $103968.2400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1708 2257 17813.661934 $890682.4900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 179 227 1837.285719 $91864.2300 $50.0000
INTR -T1013 INTERPRETER 227 301 860.073015 $43003.6400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2175 3605 26826.596876 $268265.7900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 90 115 807.114286 $58079.9400 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 4 26.000000 $1870.9600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 7.133333 $513.3100 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 4 15.285714 $1099.9600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 196 256 1901.728574 $136848.2800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 9 9 87.771429 $6316.0300 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 1.714286 $98.6800 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 6 6 51.257144 $3688.4500 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 3 5 38.571428 $2775.6000 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 7 3.832876 $440.0400 $114.8100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 4 4.000000 $1836.8800 $459.2200
SENS -V5264 EARMOLD 10 15 14.449772 $261.9700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 219 287 2251.985715 $162052.8100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 29 33 308.033334 $22166.0800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 11 15 118.504761 $8527.6100 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 5 5 44.428571 $620.2200 $13.9600
TRAV -TRAVS Travel by mile 2186 3631 26978.920687 $12005.6100 $0.4400
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Subtotal (Total Children Is Unduplicated) 2332 13332 86453.012407 $2643248.6500 $30.5700
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Total 15376 90416.368080 $2867914.7400 $31.7200
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Number of Children (Unduplicated) With at Least One Authorization 2573