Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 15261 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 175 186 347.267461 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 175 186 347.267461 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 89 110 141.641080 $6869.6400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 37 40 42.056621 $2359.3800 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 30 32 89.680952 $1420.5500 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 7 6.266667 $122.2600 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 5 3.777778 $89.4200 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 4.272223 $62.7200 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 6 12.711111 $280.5300 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 18 19 24.716667 $217.7500 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 13.911111 $402.3100 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 6 6.605556 $297.7800 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 3.266667 $45.1100 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 26 26 42.641521 $897.1800 $21.0400
AUDE -92602 REPROGRAM COCHLEAR IMPLT <7 1 1 3.333333 $202.4300 $60.7300
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 3 2.733333 $166.7300 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 3 3 3.000000 $260.8200 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 3.024202 $137.0600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 1.693151 $196.0900 $115.8100
EXIT -EXIT COS Exit 94 99 72.528769 $3626.4300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 0.142857 $10.7200 $75.0200
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 10 14 28.000000 $2100.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 9 18.000000 $999.0000 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 46 47 92.500000 $6937.5000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 24 24 48.000000 $3600.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 71 71 141.000000 $10575.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 13 13 26.000000 $1950.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 63 63 123.000000 $9225.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 11 11 21.500000 $1612.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 337 344 680.076908 $37744.2700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 112 117 234.000000 $12987.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 403 499 990.576908 $74293.2700 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 76 97 194.000000 $14550.0000 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 1 12.714286 $688.7300 $54.1700
OCTH -97165 OT EVAL LOW COMPLEXITY 12 12 13.000000 $668.3300 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 3.098630 $159.3000 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.252055 $12.9600 $51.4200
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 8.333333 $428.4200 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 13 13 26.142857 $1344.0100 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 5.007046 $257.4200 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 7 8.149772 $123.1400 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 27 27 53.541270 $2752.5600 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 6.857143 $352.5200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.8200 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 15 15 9.317809 $479.0300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.183562 $60.8500 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 15 16 146.057142 $7508.8100 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 4 4 32.000000 $1645.1200 $51.4100
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Subtotal (Total Children Is Unduplicated) 978 1828 3432.312320 $212844.7400 $62.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 73 90 99.328618 $496645.0000 $5000.0200
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 4.066667 $282.0300 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 18 19 22.296673 $5164.3600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 377 434 489.027540 $24451.3800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 50 56 34.965075 $1748.2300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 42 44 64.822147 $1620.5500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 490 609 1620.442092 $81022.2700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 27 30 98.766669 $4938.3500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 17 19 25.166669 $629.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 221 263 676.880175 $33844.1000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 14 17 54.298413 $2714.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 12 12 40.009524 $1000.2400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 201 241 636.819068 $31841.0600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 12 17 30.677778 $1533.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 14 14 43.420633 $1085.5100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 302 363 876.102394 $43805.1900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 26 28 50.011112 $2500.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 20 23 51.133335 $1278.3400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 159 171 1694.161906 $84708.2000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 9.000000 $450.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1778 2269 18844.514303 $942226.3800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 209 254 2124.319055 $106215.9700 $50.0000
INTR -T1013 INTERPRETER 188 271 831.159521 $41558.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2248 3595 28366.130205 $340393.8300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 109 132 950.114289 $68370.2700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 23.085714 $1661.2500 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 3.066667 $176.6400 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 3 3 13.085715 $941.6500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 195 240 1893.309523 $136242.6800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 6 74.142857 $5335.3300 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 12 13 95.495238 $6871.8300 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 19.276190 $1387.1200 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 6 0.945206 $108.5300 $114.8200
SENS -V5060 BEHIND EAR HEARING AID 2 2 4.000000 $918.4400 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 3.000000 $1377.6600 $459.2200
SENS -V5264 EARMOLD 12 15 17.281278 $313.3100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 245 295 2428.919051 $174785.1100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 21 22 243.285715 $17506.8500 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.300000 $132.4800 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 7 7 73.333333 $5277.0600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 26.285714 $1891.5300 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 7 10 79.142857 $1104.8400 $13.9600
TRAV -TRAVS Travel by mile 2266 3641 28423.925445 $12648.6700 $0.4500
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Subtotal (Total Children Is Unduplicated) 2408 13247 91161.514364 $2688708.7400 $29.4900
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Total 15261 94941.094145 $2901553.4700 $30.5600
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Number of Children (Unduplicated) With at Least One Authorization 2729