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: 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 3049 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 9 10 8.615873 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 10 8.615873 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 4 7.633333 $112.0600 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 4 7.633333 $54.9600 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 4 7.633333 $220.7600 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 4 7.633333 $160.6000 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 0.627397 $28.4300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 0.627397 $72.6600 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 2.000000 $100.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 15 15 15.000000 $771.1500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 16 17.000000 $873.9700 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 5 5.000000 $257.0500 $51.4100
OCTH -97166TL 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
PSTH -97161 PT EVAL LOW COMPLEXITY 11 12 12.000000 $616.9200 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 12 13 12.866667 $661.4800 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
SCREEN-T1023 SCREENING 116 121 126.133333 $6306.6700 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 28 29 29.000000 $1490.8900 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 2 2.000000 $102.8200 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 9 10 9.866667 $507.2500 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 8.000000 $411.2800 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.7200 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 3 25.714286 $1361.0500 $52.9300
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Subtotal (Total Children Is Unduplicated) 200 271 307.369079 $14660.9900 $47.7000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.333333 $116.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 11.000000 $550.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 416 575 1707.683339 $85384.2000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 1 1 2.166667 $108.3400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 258 357 1116.033339 $55801.7000 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 155 215 742.300003 $37115.0200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 255 321 896.466671 $44823.3600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 3 4 7.666666 $383.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 15 17 33.800001 $845.0000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 0.533333 $13.3300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.966667 $49.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 13 13 74.842858 $3742.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 557 694 4174.421451 $208720.8900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 6 20.342857 $1017.1400 $50.0000
INTR -T1013 INTERPRETER 3 3 20.285714 $1014.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 64 86 401.654762 $28903.0700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 5 21.857143 $1572.8400 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 24 30 246.752383 $14212.9200 $57.6000
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 5.600000 $322.5600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 100 125 524.189288 $37720.6800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 4 5 11.633334 $837.1400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 23 29 207.133332 $11922.5900 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 2.066667 $148.7200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 5.250000 $377.7900 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 3 4 2.544444 $46.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 195 246 1410.421436 $101493.8500 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 12 15 63.580952 $4575.2700 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 2 5.333333 $383.7800 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 8.700000 $121.4500 $13.9600
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Subtotal (Total Children Is Unduplicated) 825 2768 11731.559973 $643241.7600 $54.8300
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Total 3049 12047.544925 $657902.7600 $54.6100
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Number of Children (Unduplicated) With at Least One Authorization 847