Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 14459 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 237 264 16840.487297 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 250 283 166461.719840 $6192375.9700 $37.2000
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Subtotal (Total Children Is Unduplicated) 482 547 183302.207137 $6192375.9700 $33.7800
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 3.833333 $215.0500 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 4.600000 $89.7500 $19.5100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 0.077778 $5.8500 $75.1500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 4.577778 $207.4700 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 3.355555 $388.6000 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 124 163 247.370852 $12368.5500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 26 30 43.129831 $2156.5000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 52 52 93.033333 $4651.6700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 10 19.666667 $1475.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 72 74 142.027701 $10652.0800 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 16.000000 $1200.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 37 37 74.000000 $5550.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 27 27 48.977778 $2718.2700 $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 1105 1117 2222.133334 $166660.0100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 260 262 521.000000 $39075.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 202 202 400.066667 $30005.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 60 60 118.000000 $8850.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 301 301 601.000000 $45075.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 67 67 131.000000 $9825.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 649 659 1316.066667 $73041.7000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 145 146 290.000000 $16095.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 243 368 246.500083 $12672.6000 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 5 5 3.166667 $162.8000 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 0.350000 $17.9900 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 14 15 15.322222 $787.7100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 44 60 39.989685 $2055.8900 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.427778 $21.9900 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 284 336 331.202410 $17027.1500 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 22 26 19.366668 $995.6500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 7 7 9.000000 $462.6900 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 5 6 7.955556 $409.0000 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 125 206 173.704769 $8930.2000 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 6 9 6.516667 $335.0200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 7 7 30.169842 $1551.0300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 13 28 42.134128 $2166.1200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 102 125 104.016666 $5347.4900 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 10 11 11.366667 $584.3600 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 5 5 5.000000 $257.0500 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 39 44 36.077779 $1854.7700 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 3 2.405556 $123.6700 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.533333 $27.4200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 460 658 478.241290 $24586.4900 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 7 3.144444 $161.6500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 7 10 6.155556 $316.4600 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.277778 $65.6900 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.272222 $13.9900 $51.4100
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Subtotal (Total Children Is Unduplicated) 2084 5187 7910.220519 $513760.2400 $64.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 17 24 25.094444 $125472.0000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 6 9 10.311112 $515.5600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 11 19 29.900001 $6925.4600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 80 112 77.980567 $3899.0900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 3 8 8.000000 $400.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 17 20 42.830557 $1070.7700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 632 1019 1388.962699 $69448.1400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 8 8 6.311112 $315.5600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 362 551 1503.628583 $37590.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 387 1032 1131.403157 $56570.0700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 10 11.533332 $576.6600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 155 428 982.272220 $24556.8000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 111 381 461.627777 $23081.3900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 0.588889 $29.4500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 52 192 470.005559 $11750.1500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 558 852 1208.245237 $60412.2600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 6 6 4.322223 $216.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 355 528 1381.800015 $34545.0400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 6 76.285715 $3814.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 657 1088 16222.147582 $811107.5700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 46 65 758.071427 $37903.5900 $50.0000
INTR -T1013 INTERPRETER 2 2 4.500000 $225.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 288 466 6549.462682 $471299.4900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 8 9 109.142856 $7853.9200 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 316 534 10311.815063 $593960.5800 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 9 9 130.285715 $7504.4500 $57.6000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.344444 $24.7800 $71.9500
OCCT -97530TLHM OT SESSION BY OT ASST 2 3 136.571428 $7866.5200 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 155 272 4039.571420 $290687.6300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 4 5 85.000000 $6116.6000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 115 231 4065.306345 $233999.0500 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 17.571429 $1011.4100 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 24.571429 $1768.1600 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 3 15.857143 $912.7300 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 3 4 41.857143 $2409.2900 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 4 5.466666 $1255.1900 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 2 4 9.111111 $2092.0000 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 8 11 12.416667 $5702.0000 $459.2200
SENS -V5264 EARMOLD 12 18 37.555556 $680.8800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 460 736 10457.182512 $752499.0600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 12 145.285712 $10454.7600 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 21 33 545.057142 $39222.3200 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 7 55.619047 $4002.3400 $71.9600
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Subtotal (Total Children Is Unduplicated) 1452 8725 62600.873718 $3751748.8400 $59.9300
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Total 14459 253813.301374 $10457885.0600 $41.2000
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Number of Children (Unduplicated) With at Least One Authorization 2298