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 5328 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 250 305 439.137301 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 2 2 0.738889 $35.8400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 10 12 10.122222 $567.8600 $56.1000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.777778 $35.2500 $45.3200
OCTH -97165 OT EVAL LOW COMPLEXITY 8 9 3.427778 $176.2200 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 4 5 3.888889 $199.9300 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.705556 $36.2700 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 10 11 30.313491 $1558.4100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 20 23 13.427778 $690.3200 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 6 7 8.312700 $427.3600 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 3 3 1.277778 $65.6900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 14 8.805556 $452.7000 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 29 34 39.470637 $2029.2000 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 12 17 55.815873 $2869.5000 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 28 35 20.713492 $1064.8800 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.761111 $39.1300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 4 15.450001 $794.2900 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 5 8 4.377778 $225.0600 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.8200 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.077778 $4.0000 $51.4200
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.285714 $168.9200 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 100 193 223.950799 $11553.9300 $51.5900
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 4 4 11.714286 $585.7200 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.038889 $240.6300 $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 17 21 43.669049 $2183.4600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 4 6 11.355554 $283.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 38 44 124.506347 $6225.3100 $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 15 17 19.403966 $970.1900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 0.366666 $9.1700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 5 5 46.285714 $1157.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 26 188.714285 $4717.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 11 14 212.428571 $10621.4300 $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 187 264 4069.571424 $203478.5600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 309 427 6727.130148 $336356.6000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2197 3514 55033.426946 $660401.1900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 12 114.000002 $8203.4300 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 3 3 48.571428 $2797.7100 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 17 21 278.499999 $20040.8700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 12 19 322.714287 $23222.5100 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 28 33 346.785714 $24954.7100 $71.9600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 14 19 222.214286 $15990.5300 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 26 35 518.857140 $37336.9900 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 2.000000 $27.9200 $13.9600
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2310 4830 68588.254314 $1371631.9300 $20.0000
-------------------------------------------------------------------------------------------------------------------------------------
Total 5328 69251.342414 $1383185.8600 $19.9700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 2451