Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 5441 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 127 132 6229.677776 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 132 144 41674.255554 $1550282.3000 $37.2000
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Subtotal (Total Children Is Unduplicated) 257 276 47903.933330 $1550282.3000 $32.3600
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.511111 $28.6700 $56.1000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.405556 $12.3800 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.405556 $40.6500 $28.9200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.405556 $5.6000 $13.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.022222 $118.3800 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 0.622223 $31.1200 $50.0100
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 4 7.000000 $350.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 12 15 29.000000 $2175.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 36 38 67.155556 $5036.6700 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 6.005479 $450.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 7 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 22.000000 $1650.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 6 6 5.131812 $384.8900 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 25 26 49.322223 $2737.3900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 279 283 564.000000 $42300.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 41 41 81.000000 $6075.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 52 52 104.000000 $7800.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 67 67 134.000000 $10050.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 11 11 21.000000 $1575.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 153 153 304.000000 $16872.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 44 44 88.000000 $4884.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 112 138 50.346423 $2588.3100 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 3 3 -0.094444 $-4.8500 $51.3900
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 1.022222 $52.5500 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 4.444444 $228.4900 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 19 24 9.733335 $500.4000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 135 149 124.260328 $6388.2200 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 8 8 5.288888 $271.9000 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 68 82 41.476114 $2132.2900 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 4 4 0.372222 $19.1300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 0.511111 $26.2800 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 13 16 9.355555 $480.9700 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 38 42 27.340487 $1405.5700 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.127778 $6.5700 $51.4200
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.350000 $17.9900 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 26 26 13.044442 $670.6000 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 9.857143 $506.7500 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.122222 $6.2800 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 216 259 113.935923 $5857.4100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.100000 $107.9600 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 6 7 3.050000 $156.8000 $51.4100
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Subtotal (Total Children Is Unduplicated) 841 1570 1950.142598 $127253.5100 $65.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 8 9 7.788889 $38944.5000 $5000.0100
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.566666 $362.8600 $231.6100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 34 35 28.376388 $1418.8200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 1 2 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 9 9 10.683334 $267.0900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 368 448 326.388083 $16319.3400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 4 4 2.966666 $148.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 170 200 276.783338 $6919.6000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 248 459 318.755545 $15937.7300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 6 5.044444 $252.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 82 185 253.149986 $6328.7200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 68 158 102.444436 $5122.1800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 29 64 113.642860 $2841.0800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 270 311 221.906337 $11095.2600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 5 5 4.233332 $211.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 175 207 264.050002 $6601.2600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 388 476 3866.023812 $193301.3800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 21 22 152.290477 $7614.5300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 169 210 1723.151584 $123998.0700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 4 39.428571 $2837.2800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 157 183 2115.857139 $121873.4200 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 4 5 26.000000 $1497.5900 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 4.857143 $349.5200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 1.428571 $82.2900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 95 119 998.229369 $71832.6100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 21.285715 $1531.7200 $71.9600
PHY -97110HM PT SESSION BY PT ASST 78 100 944.569042 $54369.4500 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 2 20.428571 $1175.8700 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.088888 $250.0000 $229.5900
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 3.044444 $1398.0500 $459.2100
SENS -V5264 EARMOLD 5 6 5.444443 $98.7100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 257 327 2842.451582 $204543.0300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 5 38.714285 $2785.8800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 16 19 162.561906 $11697.9800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 3 19.276190 $1387.1200 $71.9600
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Subtotal (Total Children Is Unduplicated) 894 3595 14940.054895 $916670.4700 $61.3600
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Total 5441 64794.130823 $2594206.2800 $40.0400
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Number of Children (Unduplicated) With at Least One Authorization 1223