Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 7213 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 43 44 63.886505 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 43 44 63.886505 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 61 66 61.766667 $3465.1100 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 50 54 40.777777 $645.9200 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 42 50 37.961110 $740.6200 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 0.800000 $18.9400 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 9 9 7.700000 $113.0400 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 24 25 27.592856 $608.9700 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 6 3.833334 $33.7700 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 27 30 28.133334 $813.6200 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.700000 $31.5600 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 146 156 107.199984 $1480.4100 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 36 42 74.195238 $1561.0600 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 15.333333 $1333.0800 $86.9400
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 6.066667 $274.9400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 8.000000 $926.4800 $115.8100
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 22.000000 $1221.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 16 18 36.000000 $2700.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 45 56 55.044444 $2829.8300 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 2 1.233333 $63.4000 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 78 85 61.388887 $3155.9900 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 2 0.511111 $26.2800 $51.4100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.022222 $52.5500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 13 16 10.450000 $537.2300 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 13.142857 $675.6800 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.172222 $8.8500 $51.4000
OCTH -97167 OT EVAL HIGH COMPLEXITY 46 54 35.044443 $1801.6300 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 3.000000 $154.2300 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 4 4 2.366666 $121.6700 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 33 41 42.483333 $2184.0700 $51.4100
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 43 47 29.094443 $1495.7400 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 1.533333 $78.8300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 7 2.861111 $147.0900 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.327778 $16.8500 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 30 34 26.311112 $1352.6600 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 171 207 172.115078 $8848.4300 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 2.161111 $111.1000 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.422222 $21.7100 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 3 0.511111 $26.2800 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 8 11 6.472222 $332.7400 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 2.022222 $103.9600 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 3 0.605555 $31.1300 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 145 174 115.516663 $5938.6900 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 11 11 9.811111 $504.3900 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.022222 $103.9600 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 4 4.000000 $205.6400 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 15 18 12.038888 $618.9100 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 2.000000 $102.8200 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 15 17 115.428572 $5934.1900 $51.4100
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Subtotal (Total Children Is Unduplicated) 850 1307 1228.685683 $54690.4700 $44.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 5.000000 $25000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 6 6 26.644444 $1847.7900 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.588889 $40.8400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 16 16 19.733333 $4570.6300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 280 371 372.037122 $18601.9700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 7 8 10.316667 $515.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 10 11 20.283332 $507.0800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 824 1088 3199.047641 $159952.4900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 7 20.466666 $1023.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.500000 $37.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 452 552 1365.842884 $68292.2600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.633333 $31.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 7.100000 $177.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 186 223 581.042873 $29052.2200 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 3.933334 $196.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 3.700000 $92.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 480 616 1430.695271 $71534.9300 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 4 4 9.366667 $468.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 8.733333 $218.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 50 52 612.557141 $30627.9000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 4.000000 $200.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1440 1870 17269.467413 $863473.9300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 188 225 2050.621428 $102531.1400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 173 211 2146.776186 $154482.1200 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 102 122 1255.833332 $90369.8400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 6 7 67.571428 $4862.4500 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 26.285714 $1513.0000 $57.5600
SENS -V5060 BEHIND EAR HEARING AID 4 4 5.000000 $1148.0500 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 10 10 72.092063 $1307.0300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 326 411 3523.352381 $253540.5000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 3 27.285715 $1963.4800 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 14 18 282.142856 $16251.4400 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 3 3 23.714286 $1365.9400 $57.6000
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 1 1 7.571429 $436.1100 $57.6000
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Subtotal (Total Children Is Unduplicated) 1786 5862 34462.937161 $1907153.2400 $55.3400
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Total 7213 35755.509349 $1961843.7100 $54.8700
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Number of Children (Unduplicated) With at Least One Authorization 1851