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: 07-01-23 and 09-30-23 Date of Report: 10-10-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2488 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 27 28 32.150001 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 28 32.150001 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 20 20 18.855555 $914.4900 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 2.377778 $37.6600 $15.8400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.366667 $8.6800 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.494444 $7.2600 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 118 124 72.455556 $1599.1000 $22.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.366667 $7.7200 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.450000 $20.3900 $45.3200
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 2.785714 $348.2100 $125.0000
EXIT -EXIT COS Exit 1 1 1.000000 $50.0000 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 2.600000 $133.6700 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 3 32.000000 $1645.1100 $51.4100
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Subtotal (Total Children Is Unduplicated) 146 158 134.752381 $4823.7000 $35.8000
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 3 5.777778 $245.0400 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 15 18 18.377776 $91888.0000 $4999.9500
AUDE -V5160 DISPENSING FEE BINAURAL 10 10 9.033333 $2092.2900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 13 15 26.526189 $1326.3100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 7 7 5.633333 $281.6700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 8.844446 $442.2300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 4 3.788889 $189.4500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 95 108 213.320316 $10666.0000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 5.377778 $268.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.533333 $38.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 51 56 90.642064 $4532.1100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.666666 $133.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 63 73 111.491266 $5574.5400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 27.619049 $690.4800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 12 15 92.571429 $4628.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 503 614 3892.203948 $194610.2500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 29 33 175.019046 $8750.9500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 692 920 5620.838045 $67450.0800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 82 99 727.425396 $52345.5600 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 2 8.285714 $596.2400 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 39 43 311.933334 $22446.7300 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 6.600000 $474.9400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 50 62 438.620632 $31563.1500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 3 29.352381 $2112.2100 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 26 30 244.974601 $17628.3900 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.733333 $124.7300 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 1.633333 $750.0400 $459.2100
SENS -V5264 EARMOLD 3 3 2.633333 $47.7400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 91 102 676.328564 $48668.6000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 3.300000 $237.4700 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 42 49 283.938094 $20432.1700 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 3.611111 $259.8500 $71.9600
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Subtotal (Total Children Is Unduplicated) 820 2302 13054.634510 $591800.9400 $45.3300
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Total 2488 13221.536892 $596624.6400 $45.1300
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Number of Children (Unduplicated) With at Least One Authorization 838