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
Eligibility Filter: Program Patients
With the filters selected there were 15388 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 5 7 32.752381 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 7 32.752381 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 125 197 184.445283 $8945.6100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 11 11.498727 $645.0700 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.322222 $6.2900 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 7.285714 $172.4500 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 18 22 15.835160 $232.4600 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 7 5.580366 $123.1600 $22.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 4 4.332267 $196.3400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 7 4.534704 $525.1800 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 15.142857 $757.1500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 104 106 123.568311 $6178.4100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 11 20.005479 $1500.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $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 9 9 15.005479 $832.8100 $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 381 388 683.743945 $51280.8800 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 164 171 329.010958 $24675.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 132 134 262.785714 $19708.9300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 58 59 114.500000 $8587.5000 $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 472 521 923.059664 $51229.8700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 91 95 185.000000 $10267.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 113 118 224.500000 $16837.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 49 53 102.500000 $7687.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 2 9.700000 $485.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 10 12 8.226028 $422.9000 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 80 113 120.013918 $6169.9400 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 1.443683 $74.2200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 64 79 56.191018 $2888.7700 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 5 7 48.613307 $2499.2100 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 3 2.142466 $110.1500 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 3 5 24.880235 $1279.0900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 52 72 37.847565 $1945.7500 $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 14 25 17.389271 $893.9900 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.016667 $52.2700 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 50 71 79.657858 $4095.2200 $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 49 65 63.783040 $3279.0900 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 10 15 5.690412 $292.5400 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 48 60 28.911798 $1486.3600 $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 84 112 132.686323 $6821.4200 $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 14 17 12.152132 $624.7400 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.106849 $5.4900 $51.3900
SPCH -92522TL EVAL OF SPCH SOUND PROD 4 4 2.556165 $131.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 131 172 123.553003 $6351.8800 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 8 9 35.641367 $1832.3300 $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 5 6 3.838889 $197.3600 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 20 30 19.127093 $983.3200 $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 8 11 194.285714 $9988.2300 $51.4100
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Subtotal (Total Children Is Unduplicated) 1061 2849 4314.807650 $266357.2200 $61.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 138 219 774.767103 $3873836.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 6.731963 $336.6000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 2.000000 $138.7000 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 3 1.432877 $99.3700 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 8 15 21.599542 $5002.8500 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 152 178 289.325537 $14466.2900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 15 18 17.113097 $855.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 4 4 13.116667 $327.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 726 1278 4992.581315 $249629.1000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 6 11.433333 $571.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 2.000000 $50.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 379 599 2278.461533 $113923.0800 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 7 8 20.800001 $1040.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 7 29.433333 $735.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 79 121 492.040478 $24602.0400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.500000 $62.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 682 1089 4089.746398 $204487.3600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 8 10 29.533335 $1476.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 13 45.766668 $1144.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 28 34 482.480953 $24124.0500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 670 1081 16705.745213 $835287.3700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 96 126 1875.357137 $93767.8700 $50.0000
INTR -T1013 INTERPRETER 62 132 514.354661 $25717.7300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 890 2873 26859.393377 $322312.7700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 240 371 6042.439673 $434813.9900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 6 7 119.714287 $8614.6400 $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 176 286 5306.679358 $381868.6500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 14.142857 $1017.7200 $71.9600
PHY -97110HM PT SESSION BY PT ASST 3 4 41.142857 $2368.1900 $57.5600
SENS -V5060 BEHIND EAR HEARING AID 3 6 4.852054 $1114.0700 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 6 17.166666 $7883.2500 $459.2200
SENS -V5264 EARMOLD 6 10 16.296804 $295.4600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 302 425 6969.561894 $501529.7000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 13 206.142856 $14834.0400 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 3 52.142858 $727.9100 $13.9600
TRAV -TRAVS Travel by mile 1061 3573 1457971.793278 $648797.4500 $0.4500
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Subtotal (Total Children Is Unduplicated) 1149 12532 1536376.361392 $7801234.5300 $5.0800
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Total 15388 1540723.921423 $8067591.7500 $5.2400
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Number of Children (Unduplicated) With at Least One Authorization 1265