Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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 6173 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 6 6 6.177778 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6 6 6.177778 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 73 89 57.052587 $2767.0700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 6 12.570777 $705.2300 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.666667 $10.5600 $15.8400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 8.000000 $189.3600 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 7 3.878234 $56.9300 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $22.0700 $22.0700
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 0.511111 $38.4000 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.511111 $23.1600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 1.511111 $175.0000 $115.8100
EXIT -EXIT COS Exit 7 7 5.616667 $280.8400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 8 12.500000 $937.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 1.505479 $83.5600 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 81 86 137.704560 $10327.8600 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 32 32 59.000000 $4425.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 32 33 63.000000 $4725.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 11 11 20.500000 $1537.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 89 105 180.999798 $10045.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 36 36 69.500000 $3857.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 27 48.500000 $3637.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 14 17 34.000000 $2550.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 6 8 1.708980 $87.8600 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 71 80 59.299849 $3048.6300 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 7 8 7.722222 $397.0000 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 28 30 27.884791 $1433.5600 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 5 26.828180 $1379.2400 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 3 1.252054 $64.3700 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.252055 $12.9600 $51.4200
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 18 19.139280 $983.9600 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 10 3.999317 $205.6100 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 0.650685 $33.4500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 55 61 64.193401 $3300.2000 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 4 4 4.988889 $256.4800 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 24 26 11.721538 $602.6100 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.252055 $12.9600 $51.4200
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 3.066667 $157.6600 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 4 5 1.650000 $84.8300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 91 100 52.224563 $2684.9100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 6 7 4.533333 $233.0600 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 1.511111 $77.7000 $51.4200
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 5 0.780823 $40.1400 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 4 0.715068 $36.7700 $51.4200
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.252055 $12.9600 $51.4200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 35 37 32.772755 $1684.8500 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 0.309208 $15.9000 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 6 2.129071 $109.4600 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 3 0.252055 $12.9600 $51.4200
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 4 28.285713 $1454.1700 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 385 923 1089.420410 $65683.6400 $60.2900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 77 94 218.709283 $1093548.5000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 1.666667 $115.5900 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.866667 $129.4600 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.666667 $617.6600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 69 73 88.713042 $4435.6800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 10 10 11.263889 $563.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 5 5 4.574999 $114.3700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 447 596 1352.515120 $67625.9700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 4 7.666666 $383.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.633333 $65.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 267 336 707.883026 $35394.2500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 2.366666 $118.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 8 13.800000 $345.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 27 59.076519 $2953.8400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 4.100001 $102.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 421 515 1115.222257 $55761.2900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 3.066667 $153.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 25.152382 $628.8100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 101.857143 $5092.8700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 391 486 4054.789682 $202739.6900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 74 80 752.923813 $37646.2300 $50.0000
INTR -T1013 INTERPRETER 20 33 102.057989 $5102.9100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 466 1100 6019.489645 $72234.0000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 158 192 1656.503971 $119202.0900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 11 11 113.714284 $8182.9000 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 3.857143 $277.5600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 99 117 1132.926191 $81525.4200 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 5 36.000000 $2590.5600 $71.9600
PHY -97110HM PT SESSION BY PT ASST 6 8 61.571431 $3544.0400 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.432877 $49.7000 $114.8200
SENS -V5060 BEHIND EAR HEARING AID 2 3 2.511111 $576.5700 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.666667 $1224.6000 $459.2300
SENS -V5264 EARMOLD 4 6 3.356164 $60.8500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 172 200 1683.825401 $121168.1800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 13 13 113.142855 $8141.7800 $71.9600
TRAV -TRAVS Travel by mile 510 1287 349037.078284 $155321.5000 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 583 5244 368501.648502 $2087738.3600 $5.6700
-------------------------------------------------------------------------------------------------------------------------------------
Total 6173 369597.246690 $2153422.0000 $5.8300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 628