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: 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 3059 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 92 99 2367.899999 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 23 23 7519.733333 $279734.0800 $37.2000
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Subtotal (Total Children Is Unduplicated) 115 122 9887.633332 $279734.0800 $28.2900
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.800000 $44.8800 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.366667 $26.6600 $19.5100
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.488889 $22.1600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 29 31 42.957687 $2147.8900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 6 6 5.574276 $278.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 11 11 20.300000 $1015.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 2.577778 $193.3400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 39 39 77.000000 $5775.0000 $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 17 17 34.000000 $2550.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 1.000000 $75.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 59 59 118.000000 $6549.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 28.000000 $1554.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 18 19 6.944446 $357.0200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 1.383333 $71.1200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 25 26 14.577093 $749.4100 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.366667 $18.8500 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 10 12 3.427777 $176.2200 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.366667 $18.8500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 12.857143 $660.9800 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 3.638889 $187.0800 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 6 7 3.800000 $195.3600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 28 34 16.880160 $867.8100 $51.4100
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Subtotal (Total Children Is Unduplicated) 220 323 457.307472 $28063.9700 $61.3700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 8 4.000000 $20000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 4 5 5.000000 $1158.1000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 28 28 16.938892 $846.9600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 4 4.000000 $200.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 5 3.033334 $75.8400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 352 464 321.598407 $16079.9000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 3 3 0.961111 $48.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 190 236 353.704765 $8842.6300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 201 438 279.183329 $13959.1500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 5 3.822222 $191.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 77 169 242.444436 $6061.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 73 176 104.994447 $5249.7400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 39 85 118.350001 $2958.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 316 404 281.622223 $14081.1200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 0.422222 $21.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 185 225 320.727780 $8018.2000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 3 18.428572 $921.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 108 142 1099.742856 $54987.1200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 8 55.571429 $2778.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 31 36 267.821430 $19272.4200 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 30 36 344.428573 $19839.0600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 27 37 291.761904 $20995.1900 $71.9600
PHY -97110HM PT SESSION BY PT ASST 13 17 132.428571 $7622.5800 $57.5600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 1.785714 $102.7800 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 5.714286 $328.9200 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 2 3 3.000000 $688.8300 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 3 3 4.966667 $90.0500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 56 68 470.285717 $33841.7500 $71.9600
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Subtotal (Total Children Is Unduplicated) 592 2614 4759.738888 $260408.4800 $54.7100
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Total 3059 15104.679692 $568206.5300 $37.6200
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Number of Children (Unduplicated) With at Least One Authorization 742