Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 2983 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 29 32 39.883334 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 30 33 40.883334 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 18 18 16.411112 $795.9400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.205556 $11.5300 $56.1100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 2.000000 $31.6800 $15.8400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.505556 $11.9700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 0.711112 $10.4400 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 109 122 70.600019 $1558.1800 $22.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.505556 $10.6400 $21.0400
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 1.428571 $178.5800 $125.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 1.000000 $75.0000 $75.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 13.000000 $668.3300 $51.4100
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Subtotal (Total Children Is Unduplicated) 133 152 107.367482 $3403.7000 $31.7000
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 3 3.177778 $134.7700 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 14 15 13.955556 $69778.0000 $5000.0200
AUDE -V5160 DISPENSING FEE BINAURAL 11 12 10.011112 $2318.7900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 10 14 34.500000 $1725.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 8 10 9.966667 $498.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 12 11.677778 $583.8900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 3 4.855555 $242.7800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 107 128 137.122224 $6856.1200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 5.000000 $250.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 3.011111 $75.2800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 50 57 94.100000 $4705.0000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 3.783333 $189.1700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 53 64 97.566667 $4878.3400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 3 2.911111 $145.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 18.696826 $467.4200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 14 14 112.504764 $5625.2400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 553 676 4231.587322 $211579.4100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 37 47 243.428570 $12171.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 846 1326 7134.707173 $85616.5000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 76 90 546.869050 $39352.7100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.285714 $164.4800 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 39 46 241.142858 $17352.6500 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 22.638095 $1629.0400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 55 64 484.904767 $34893.7400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 3.104762 $223.4100 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 34 43 298.749209 $21498.0200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 25.714286 $1850.4000 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.011111 $464.3200 $459.2100
SENS -V5264 EARMOLD 3 3 2.855555 $51.7700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 75 101 593.347622 $42697.3100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 17.834920 $1283.3900 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 33 37 222.239683 $15992.3800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 8.555556 $615.6600 $71.9600
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Subtotal (Total Children Is Unduplicated) 883 2798 14644.816735 $586139.9200 $40.0200
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Total 2983 14793.067551 $589543.6200 $39.8500
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Number of Children (Unduplicated) With at Least One Authorization 907