Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 04
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 11130 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 250 305 439.137301 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 250 305 439.137301 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 10 24.620635 $1194.1000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 23 29 25.966666 $1456.7300 $56.1000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.777778 $35.2500 $45.3200
OCTH -97165 OT EVAL LOW COMPLEXITY 63 75 87.530954 $4499.9800 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.211111 $10.8500 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 30 37 26.383333 $1356.3700 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.705556 $36.2700 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 6 6 3.433333 $176.5100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 75 108 161.565874 $8306.1100 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.722222 $37.1300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 107 154 81.700788 $4200.2100 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 28 33 24.396034 $1254.2100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 13 18 9.111109 $468.3900 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 2 1.033334 $53.1300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 3 3 2.205556 $113.3900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 61 93 45.455554 $2336.8600 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 96 141 180.611902 $9285.2500 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 2.000000 $30.2200 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 44 59 78.082542 $4014.2400 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 107 163 116.087299 $5968.0400 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 3 4 2.494444 $128.2400 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 11 19 24.327777 $1250.6900 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 38 48 24.050004 $1236.4300 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 8 11 6.044445 $310.7500 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 27 38 15.538887 $798.8400 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 6 1.577778 $81.1100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 3 27.142857 $1395.4200 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 4 5 59.714286 $3069.9100 $51.4100
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Subtotal (Total Children Is Unduplicated) 439 1073 1033.692058 $53114.9100 $51.3800
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 11.714286 $585.7200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 2.000000 $138.7000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 6 7 6.038889 $1398.7300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 70 326 211.837711 $10591.9400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 18 22 46.735716 $2336.7900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 6 11.355554 $283.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 40 46 141.244443 $7062.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 9 15.166664 $379.1600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 3 0.777778 $38.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 1.788889 $44.7200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 17 19 23.099204 $1154.9600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 0.366666 $9.1700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 22 27 282.714286 $7067.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 265 686 6695.928566 $167398.2300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 13 17 248.142856 $12407.1400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 15.428571 $771.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1006 1458 21864.397624 $1093219.8600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1399 2078 33106.900751 $1655345.3100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2198 3516 55088.426946 $661061.1900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 114 154 1835.785712 $132103.1400 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 25.857143 $1860.6800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 43 64 522.594046 $30101.4200 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 193 317 4153.403970 $298878.9600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 20.142857 $1449.4800 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 78 114 1339.571432 $96395.5500 $71.9600
PHY -97110HM PT SESSION BY PT ASST 34 66 437.285712 $25170.1800 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 8.571429 $493.3700 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 143 253 3001.214286 $215967.4500 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 21.714286 $1562.5600 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 4 4.000000 $1836.8800 $459.2200
SENS -V5264 EARMOLD 6 9 8.038889 $145.7500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 112 162 1318.709916 $94894.3900 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.571429 $205.7100 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 175 333 3638.742854 $261844.0100 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 4 39.642856 $2852.7100 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 18 33 251.999999 $3517.9200 $13.9600
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Subtotal (Total Children Is Unduplicated) 2556 9752 134407.912216 $4791150.0600 $35.6500
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Total 11130 135880.741575 $4844264.9800 $35.6500
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Number of Children (Unduplicated) With at Least One Authorization 2676