Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 6880 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 27 30 38.649209 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 27 30 38.649209 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 7 26.766667 $392.9400 $14.6800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 7 26.766667 $235.8100 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 7 26.766667 $774.0900 $28.9200
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 7 26.766667 $563.1700 $21.0400
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 7 2.432875 $110.2500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 7 3.967122 $459.4200 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 6 6 6.000000 $300.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1 1 1.000000 $50.0000 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 23 26 26.000000 $1336.6600 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 32 36 39.733333 $2042.6900 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 7 8 8.000000 $411.2800 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 12 13 13.000000 $668.3300 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 25 26 31.166667 $1602.2800 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 254 272 281.243378 $14062.1700 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 48 51 51.000000 $2621.9100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 3 3.000000 $154.2300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 17 18 23.200000 $1192.7100 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 4 4.000000 $205.6400 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 30 34 36.500000 $1876.4700 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 7 8 8.000000 $411.2800 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 6 12 128.180952 $6589.7800 $51.4100
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Subtotal (Total Children Is Unduplicated) 394 573 786.490995 $36729.4300 $46.7000
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 4 14.333334 $716.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 8 9 52.399999 $2620.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 729 1371 7329.716678 $366485.8900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 3 4 21.000000 $1050.0000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 5.466667 $136.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 439 747 4532.723823 $226636.2600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 217 461 2969.666674 $148483.3700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 469 768 3987.416676 $199370.8800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 5 31.566666 $1578.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 22 31 136.414287 $3410.3600 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 3.100000 $77.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 3.100000 $77.5000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 19 27 279.566667 $13978.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 941 1580 17176.332154 $858816.5400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 8 10 84.314286 $4215.7100 $50.0000
INTR -T1013 INTERPRETER 5 6 67.380953 $3369.0500 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 123 197 1766.515471 $127118.4200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 7 12 100.390476 $7224.1000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 49 77 982.823807 $56610.6500 $57.6000
OCCT -97530TLGTHM OT SESSION BY OT ASST 2 3 17.090477 $984.4100 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 152 272 2124.705956 $152893.9000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 9 11 96.852382 $6969.5100 $71.9600
PHY -97110HM PT SESSION BY PT ASST 33 58 777.404759 $44747.4300 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 5 46.659523 $2685.7300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 12.200000 $877.9100 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 4 20.066667 $1444.0000 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 36.000000 $2072.1600 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 5.166667 $297.4000 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 4.000000 $918.4400 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 2.000000 $918.4400 $459.2200
SENS -V5264 EARMOLD 4 7 8.922221 $161.7600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 372 572 5744.910709 $413403.7700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 15 21 291.761904 $20995.1800 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 3 17.600000 $1266.5000 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 12.133333 $169.3800 $13.9600
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Subtotal (Total Children Is Unduplicated) 1383 6277 48761.703216 $2672782.1200 $54.8100
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Total 6880 49586.843420 $2709511.5500 $54.6400
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Number of Children (Unduplicated) With at Least One Authorization 1416