Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4764 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 122 131 111.567453 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 122 131 111.567453 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 1.505556 $73.0200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 15 17 15.750000 $883.5800 $56.1000
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 1.150000 $59.1200 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 15 15 5.238892 $269.3500 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 0.511111 $26.2800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 10 13 3.816668 $196.2200 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 91 112 36.500803 $1876.5600 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.383334 $19.7100 $51.4200
PSTH -97161TL PT EVAL LOW COMPLEXITY 3 4 1.377778 $70.8300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 0.505556 $25.9900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 8 2.061112 $105.9700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 84 104 62.225408 $3199.0600 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.1100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 1.516667 $77.9700 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 85 102 35.435725 $1821.8100 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 0.316667 $16.2800 $51.4200
SPCH -92522TL EVAL OF SPCH SOUND PROD 8 12 3.155555 $162.2200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 7 1.205554 $61.9700 $51.4000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 6 2.727777 $140.2300 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 6 0.750000 $38.5600 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 13.000000 $668.3300 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 4 5 30.142858 $1549.6400 $51.4100
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Subtotal (Total Children Is Unduplicated) 240 432 220.477021 $11368.1000 $51.5600
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 39 152 53.524998 $2676.2400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 12 12 23.907938 $1195.4000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 3.111110 $77.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 23 25 45.400793 $2270.0400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 2 2.366666 $59.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2 2 0.355556 $17.7800 $50.0100
CONPP -CONPP CONSULT, PT, PHONE 1 1 0.744444 $18.6100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 10 10 6.407143 $320.3600 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 1.857143 $46.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 158 272 1638.142853 $40953.5700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 21.714286 $1085.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 172 201 1431.142857 $71557.1400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1130 1364 12682.806327 $634140.4800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1256 1542 13966.155544 $167593.9100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 6 8 43.571430 $3135.4000 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 144 198 1510.499999 $108695.5400 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 2.857143 $205.6000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 7 9 57.000002 $4101.7100 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 115 171 1185.000000 $85272.6100 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 3 4 4.000000 $72.5200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5 6 41.428572 $2981.1900 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 132 206 1209.862700 $87061.7300 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 3 9.357143 $673.3400 $71.9600
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Subtotal (Total Children Is Unduplicated) 1506 4201 33946.214647 $1215708.7300 $35.8100
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Total 4764 34278.259121 $1227076.8200 $35.8000
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Number of Children (Unduplicated) With at Least One Authorization 1598