Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 4397 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 87 95 68.049199 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 87 95 68.049199 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 6 8 7.272222 $407.9700 $56.1000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.244444 $12.5600 $51.4000
OCTH -97165TL OT EVAL LOW COMPLEXITY 6 6 2.461111 $126.5300 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 3 3 1.144444 $58.8300 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 4 0.994445 $51.1300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 115 126 69.542848 $3575.1600 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.305556 $15.7100 $51.4200
PSTH -97161TL PT EVAL LOW COMPLEXITY 4 4 1.044444 $53.6900 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 0.116667 $6.0000 $51.4200
PSTH -97163TL PT EVAL HIGH COMPLEXITY 90 105 37.729828 $1939.6700 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.1100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.511111 $26.2800 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 105 119 76.926178 $3954.7200 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.288889 $14.8500 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 3 0.822222 $42.2700 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 1.511111 $77.6900 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.994444 $51.1200 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 38.285714 $1968.2700 $51.4100
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Subtotal (Total Children Is Unduplicated) 235 392 241.706789 $12423.8300 $51.4000
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.111111 $7.7000 $69.3400
AUDE -V5160 DISPENSING FEE BINAURAL 5 7 7.000000 $1621.3400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 55 133 40.961108 $2048.0400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 14 15 13.788887 $689.4400 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 13 14 13.255555 $662.7800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 5 4.577776 $228.8800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5 5 10.426984 $521.3500 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 14.142857 $353.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 171 229 1889.428562 $47235.8100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1044 1173 12420.571386 $621029.2200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 300 302 2147.714293 $107385.7600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1252 1475 14505.226949 $174062.8900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 10.785714 $776.1400 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 179 203 1587.911909 $114266.2500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 3 3 12.785715 $920.0600 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 131 151 1209.071434 $87004.8200 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 4 4.000000 $1836.8800 $459.2200
SENS -V5264 EARMOLD 4 6 6.000000 $108.7800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1 1 4.642857 $334.1000 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 148 176 1341.500002 $96534.4300 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 7.428571 $534.5600 $71.9600
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Subtotal (Total Children Is Unduplicated) 1506 3910 35252.331670 $1258277.5900 $35.6900
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Total 4397 35562.087658 $1270701.4200 $35.7300
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Number of Children (Unduplicated) With at Least One Authorization 1568