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 10545 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 124 140 143.182542 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 5.142857 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 125 141 148.325399 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 71 94 103.877233 $5038.0400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 10 9.446576 $529.9500 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 8.285714 $131.2500 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.5100 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.6700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $14.6800 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.000000 $7.2000 $7.2000
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $45.0800 $45.0800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 5.466667 $115.0200 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.000000 $86.9400 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
EXIT -EXIT EXIT ASSESSMENT 47 49 55.793934 $2789.7000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 12 12 24.000000 $1800.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 10 10 18.500000 $1387.5000 $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 14 14 28.000000 $2100.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 40 40 77.500000 $4301.2500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 13 13 26.600000 $1476.3000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 30 37 73.000000 $5475.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 11 13 26.000000 $1950.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 6.000000 $308.4600 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.079452 $4.0800 $51.3800
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 3.000000 $154.2300 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 9.176190 $485.7000 $52.9300
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Subtotal (Total Children Is Unduplicated) 219 332 506.725766 $30015.1100 $59.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 25 34.102805 $170513.5000 $4999.9800
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 437 503 579.526304 $28976.3100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 21 26 1.584936 $79.2200 $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 20 23 36.322224 $908.0600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 159 192 445.634129 $22281.7100 $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 181 230 498.864288 $24943.2300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 22 28 53.433332 $2671.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 10 10 18.988890 $474.7300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 297 370 808.653182 $40432.6900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 30 40 77.661110 $3883.0500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 17 21 60.166668 $1504.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 90 102 815.980956 $40799.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 170 203 1609.523815 $80476.1400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 13 114.428572 $5721.4300 $50.0000
INTR -T1013 INTERPRETER 198 263 786.573015 $39328.6500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2175 3597 26784.025449 $267840.0800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 21 24 179.919047 $12946.9900 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 6.000000 $431.7600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 3 8.428571 $606.5200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 25 30 193.957143 $13957.1500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 13.571429 $976.6000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 1.714286 $98.6800 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 30 36 254.485714 $18312.7800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 5 36.714286 $2641.9500 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.428571 $30.8400 $71.9600
TRAV -TRAVS Travel by mile 2186 3624 26938.777831 $11987.7400 $0.4400
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Subtotal (Total Children Is Unduplicated) 2284 10072 61929.530258 $867059.3800 $14.0000
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Total 10545 62584.581423 $897074.4900 $14.3300
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Number of Children (Unduplicated) With at Least One Authorization 2379