Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 2847 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 9 9 7.222222 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 7.222222 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 4 6.433334 $94.4400 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 4 6.433334 $56.6800 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 4 6.433334 $186.0500 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 4 6.433334 $135.3600 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 0.528768 $23.9700 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 0.780823 $90.4200 $115.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 9.000000 $462.6900 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 8.000000 $411.2800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 4 4 4.000000 $205.6400 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 5.000000 $257.0500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 5.000000 $257.0500 $51.4100
SCREEN-T1023 SCREENING 57 59 59.000000 $2950.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 22 23 24.200000 $1244.1200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $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 2 2 2.000000 $102.8200 $51.4100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 9 9 53.161904 $2733.0600 $51.4100
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Subtotal (Total Children Is Unduplicated) 117 151 200.404831 $9416.2700 $46.9900
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 9 9 21.766667 $1088.3400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 397 559 1915.223816 $95761.2200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 239 317 1046.257141 $52312.8500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 147 211 755.999997 $37799.9900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 253 293 927.600002 $46380.0100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 2.466667 $123.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 13 41.390477 $1034.7600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 8 57.352379 $2867.6200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 604 731 4552.433329 $227621.7400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 15 17 88.433334 $4421.6700 $50.0000
INTR -T1013 INTERPRETER 1 1 0.700000 $35.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 54 73 361.247625 $25995.4100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 10 10 39.566666 $2847.2100 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 24 29 101.623810 $5853.5400 $57.6000
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 1.571429 $90.5100 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 115 135 601.327388 $43271.5200 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 6 15.100000 $1086.6000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 23 27 161.954762 $9322.1100 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 2 19.276190 $1109.5400 $57.5600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 3 6.833333 $491.7200 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 3 4 3.166666 $57.4100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 187 230 1213.254752 $87305.7700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 23.133333 $1664.6700 $71.9600
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Subtotal (Total Children Is Unduplicated) 869 2687 11961.679763 $649920.1700 $54.3300
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Total 2847 12169.306816 $659336.4500 $54.1800
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Number of Children (Unduplicated) With at Least One Authorization 890