Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 2261 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 35 35 65.516667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 35 35 65.516667 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 24 28 25.022221 $1213.5700 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 2.511111 $39.7800 $15.8400
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 123 126 74.094445 $1635.2700 $22.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.511111 $23.1600 $45.3200
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 6.133333 $315.3100 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 3 15.514285 $797.5900 $51.4100
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Subtotal (Total Children Is Unduplicated) 148 163 124.786506 $4076.0900 $32.6600
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 3 5.400000 $229.0100 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 23 36 31.366666 $156833.0000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 9.022222 $2089.7200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 14 17 19.400000 $970.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 2 2 1.250000 $62.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 2 1.400000 $35.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 11 14 23.778572 $1188.9400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 90 106 173.823016 $8691.1600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 3.461111 $173.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.166667 $4.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 60 71 116.674601 $5833.7200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 84 98 113.338885 $5666.9400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 3 5.200000 $260.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 12.204762 $305.1200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 8 65.238096 $3261.9100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 485 575 3217.934122 $160896.7000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 37 43 280.095238 $14004.7700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 413 571 2615.741281 $31388.8800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 82 99 673.761907 $48483.9100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 57 68 360.276192 $25925.4900 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 6 6 30.209523 $2173.8800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 42 52 402.495239 $28963.5500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 4 7 39.500001 $2842.4200 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 32 45 277.015874 $19934.0800 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 27.704762 $1993.6300 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.022222 $469.4100 $459.2100
SENS -V5264 EARMOLD 2 2 2.022222 $36.6600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 89 108 618.700003 $44521.6800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 4 5.066667 $364.6000 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 72 88 486.577778 $35014.1300 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 13.661904 $983.1100 $71.9600
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Subtotal (Total Children Is Unduplicated) 859 2063 9648.652390 $604826.5100 $62.6900
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Total 2261 9838.955563 $608902.6000 $61.8900
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Number of Children (Unduplicated) With at Least One Authorization 890