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 10588 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 151 159 220.961110 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 151 159 220.961110 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 73 89 108.620424 $5268.1300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 10 11 9.358904 $525.0300 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 6 6 18.571429 $294.1700 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.5100 $19.5100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $21.0400 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.000000 $86.9400 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.366667 $16.6200 $45.3200
EXIT -EXIT COS Exit 89 92 66.028769 $3301.4300 $50.0000
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 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 18.000000 $1350.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 20 20 39.000000 $2164.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 8 9 18.000000 $999.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 23 31 61.000000 $4575.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 6.000000 $450.0000 $75.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 4.000000 $205.6400 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 8.000000 $411.2800 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 6.857143 $352.5200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 15.504761 $797.1000 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 232 311 418.308097 $23310.2000 $55.7200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 17 21 20.892303 $104461.5000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 375 432 486.527540 $24326.3800 $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 16 18 23.566669 $589.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 220 262 673.813508 $33690.7600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 14 17 54.298413 $2714.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 10 10 37.476191 $936.9100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 199 239 630.685734 $31534.3900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 12 17 30.677778 $1533.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 12 12 41.809522 $1045.2400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 300 360 865.502394 $43275.1900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 26 28 50.011112 $2500.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 17 20 44.800002 $1120.0100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 89 96 963.828574 $48191.4700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 176 210 1801.900000 $90095.0500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 41 48 402.376191 $20118.8200 $50.0000
INTR -T1013 INTERPRETER 164 241 760.302378 $38015.1400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2248 3595 28366.130205 $340393.8300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 23 148.861906 $10712.1100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 27 31 231.128571 $16632.0100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 34.714286 $2498.0400 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 4 4 19.676191 $1415.8900 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 1 1 2.000000 $459.2200 $229.6100
SENS -V5264 EARMOLD 1 1 1.266667 $22.9700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 37 43 302.385715 $21759.6800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 37.285714 $2683.0900 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $945.7600 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 13.142857 $183.4700 $13.9600
TRAV -TRAVS Travel by mile 2265 3639 28417.496873 $12645.8100 $0.4500
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Subtotal (Total Children Is Unduplicated) 2371 10118 66309.838991 $945239.6500 $14.2500
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Total 10588 66949.108198 $968549.8500 $14.4700
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Number of Children (Unduplicated) With at Least One Authorization 2503