Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 11037 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 2 2 12.052381 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 2 2 12.052381 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 78 122 81.896426 $3971.9800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 9 4.714383 $264.4700 $56.1000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $23.6700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 12 15 10.169863 $149.2900 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 6 5.078996 $112.0900 $22.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 4 4.332267 $196.3400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 3 1.402740 $162.4500 $115.8100
EXIT -EXIT EXIT ASSESSMENT 75 76 91.562755 $4578.1300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 6.005479 $450.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 5.005479 $277.8100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 269 276 475.711071 $35678.4000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 114 120 229.510958 $17213.3300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 90 92 181.500000 $13612.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 45 46 89.500000 $6712.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 327 363 626.241076 $34756.4300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 66 70 136.500000 $7575.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 79 83 157.500000 $11812.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 32 36 70.000000 $5250.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 2 9.700000 $485.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 1.688889 $86.8300 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 50 69 91.814601 $4720.1900 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 0.988888 $50.8300 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 39 48 29.960273 $1540.2500 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 6 48.347554 $2485.5400 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.142466 $7.3300 $51.4200
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 3 24.198043 $1244.0200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 32 45 20.981658 $1078.6700 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 2 1.361111 $69.9700 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 4 1.577778 $81.1100 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 20.834127 $1071.0900 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 9 5.299316 $272.4400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 36 52 67.097128 $3449.4700 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.501370 $25.7800 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 31 39 27.042390 $1390.2500 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 5 8 3.520549 $180.9800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 38 46 18.525344 $952.3900 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.498630 $25.6300 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 3 1.854262 $95.3300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 56 71 108.826734 $5594.8000 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 1.366666 $70.2600 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.672222 $34.5600 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 8 10 8.348326 $429.1900 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.106849 $5.4900 $51.3900
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 3 1.556165 $80.0000 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 64 82 64.478723 $3314.8600 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 8.404577 $432.0900 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 1.205556 $61.9800 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.164307 $59.8600 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 4 2.316667 $119.1000 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 12 15 8.834019 $454.1600 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 4 2.127093 $109.3500 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.532877 $27.4000 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 6 8 146.714285 $7542.5800 $51.4100
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Subtotal (Total Children Is Unduplicated) 726 1896 2923.220936 $181359.2300 $62.0400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 87 138 463.234576 $2316173.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 4.398630 $219.9300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 2 0.432877 $30.0200 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 3 6 5.488432 $1271.2200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 105 128 243.889078 $12194.4600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 9 11 15.016667 $750.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 13.050000 $326.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 548 967 3826.376558 $191318.8800 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 5 5 11.333333 $566.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 284 447 1743.047248 $87152.3600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 6 6 14.466667 $723.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 7 29.433333 $735.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 60 88 379.040479 $18952.0400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 510 812 3065.451160 $153272.5900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 5 6 17.900001 $895.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 11 39.966668 $999.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 14 18 250.790477 $12539.5300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 505 816 12476.461092 $623823.1400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 78 104 1659.714281 $82985.7200 $50.0000
INTR -T1013 INTERPRETER 52 111 450.604661 $22530.2300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 650 2157 19733.223553 $236798.7100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 149 220 3660.449203 $263405.9300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 5 6 92.000001 $6620.3200 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 3 4 48.571429 $2797.7100 $57.6000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 8.000000 $575.6800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 121 191 3470.893647 $249765.5000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 2 3 39.714286 $2285.9600 $57.5600
SENS -V5060 BEHIND EAR HEARING AID 2 5 4.353424 $999.5800 $229.6100
SENS -V5264 EARMOLD 2 5 5.030137 $91.2000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 169 227 3815.742854 $274580.8700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 9 128.571428 $9252.0000 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 3 52.142858 $727.9100 $13.9600
TRAV -TRAVS Travel by mile 777 2619 1077772.502858 $479608.7700 $0.4500
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Subtotal (Total Children Is Unduplicated) 827 9139 1133543.291896 $5055020.8300 $4.4600
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Total 11037 1136478.565213 $5236380.0600 $4.6100
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Number of Children (Unduplicated) With at Least One Authorization 895