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: 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 3876 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 49 57 53.815081 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 49 57 53.815081 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 18 19 19.433333 $1090.2100 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 16.285714 $257.9700 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 13.714286 $267.5700 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 6.833333 $161.7400 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $14.6800 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 3 0.611111 $13.4900 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 4 4.227777 $30.4400 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 6 4.772221 $138.0100 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.833333 $127.7300 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 25 27 20.155554 $278.3500 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 7 8.833333 $185.8500 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
EXIT -EXIT EXIT ASSESSMENT 11 11 12.000000 $600.0000 $50.0000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 2.000000 $102.8200 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 12 16 9.405556 $483.5400 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 1.572222 $80.8300 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.811111 $41.7000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 5 5 3.672222 $188.7900 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 2.500000 $128.5300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 13 14 9.905556 $509.2500 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 3 0.983333 $50.5500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 6 1.527779 $78.5500 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 6 5.344444 $274.7600 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 32 35 27.850000 $1431.7700 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.650000 $33.4200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 19 22 23.008730 $1182.8800 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.500000 $77.1200 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 4 2.500000 $128.5300 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.500000 $25.7100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.155556 $51.8400 $44.8600
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Subtotal (Total Children Is Unduplicated) 155 221 213.586504 $8561.5200 $40.0800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.000000 $100.0000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 239 335 260.050611 $13002.7000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 1 2 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 11 13 31.775001 $794.3800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 833 1118 2831.985497 $141599.2900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 3 4 11.100001 $555.0100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.333333 $33.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 407 526 1090.878573 $54543.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 4 11.600000 $290.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 202 255 619.280954 $30964.0600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 2 3.000000 $75.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 441 578 1144.088886 $57204.4300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 1 1 6.428571 $321.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 9 16.633334 $415.8400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 72 83 638.266667 $31913.3600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 349 450 3876.117476 $193805.7000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 55 69 563.885716 $28194.2600 $50.0000
INTR -T1013 INTERPRETER 2 2 2.171429 $108.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 2 2.714285 $27.1400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 20 29 220.071431 $15836.3300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 22 28 228.604761 $16450.3900 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 8.000000 $460.4800 $57.5600
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 59 75 648.366667 $46656.4600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 3 23.714285 $1706.4900 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.571429 $148.1100 $57.6000
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Subtotal (Total Children Is Unduplicated) 1162 3598 12252.638907 $645857.4000 $52.7100
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Total 3876 12520.040492 $654418.9200 $52.2700
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Number of Children (Unduplicated) With at Least One Authorization 1215