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 7198 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 228 255 16305.220630 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 33 37 24542.322222 $912974.3900 $37.2000
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Subtotal (Total Children Is Unduplicated) 261 292 40847.542852 $912974.3900 $22.3500
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 -V5010 ASSESSMENT FOR HEARING AID 1 2 4.577778 $207.4700 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 113 147 223.387519 $11169.3900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 22 26 37.124352 $1856.2200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 49 49 89.388889 $4469.4500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 5.666667 $425.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 11 22.000000 $1650.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 6.955556 $386.0400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 129 130 260.000000 $19500.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 24 25 49.000000 $3675.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 38 38 75.000000 $5625.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 7 7 13.000000 $975.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 48 48 96.000000 $7200.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 9 9 18.000000 $1350.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 193 194 388.000000 $21534.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 44 44 86.000000 $4773.0000 $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 29 35 19.638891 $1009.6500 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.444444 $22.8500 $51.4000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 10 5.588888 $287.3200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 40 45 40.584934 $2086.4800 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 6 7 3.850000 $197.9300 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 21 32 17.083334 $878.2600 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.011111 $51.9800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 24.714286 $1270.5600 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 3 1.705556 $87.6800 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 17 20 12.805555 $658.3300 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 9 10 11.483333 $590.3600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 61 80 61.390480 $3156.1100 $51.4100
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Subtotal (Total Children Is Unduplicated) 612 999 1609.834906 $97416.4800 $60.5100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 16 16.966666 $84833.0000 $4999.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 4 3.455556 $172.7800 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 6 9 14.577778 $3376.5100 $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 1018 1388.796032 $69439.8100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 8 8 6.311112 $315.5600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 362 550 1503.128583 $37578.2500 $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 558 851 1208.078570 $60403.9200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 6 6 4.322223 $216.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 355 527 1381.300015 $34532.5400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 6 76.285715 $3814.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 203 329 4896.938091 $244846.9700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 12 19 253.214283 $12660.7300 $50.0000
INTR -T1013 INTERPRETER 2 2 4.500000 $225.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 66 959.335713 $69033.8300 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 48 70 1339.615872 $77161.8500 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 59.857143 $3447.7700 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 38 67 921.509520 $66311.8400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 19 33 489.142858 $28155.0600 $57.5600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 2 14.000000 $805.8400 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 1 2 15.714286 $904.5200 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 3.111111 $714.3400 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 2 4 9.111111 $2092.0000 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 3.627778 $1665.9600 $459.2200
SENS -V5264 EARMOLD 6 7 21.666667 $392.8200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 85 120 1730.633324 $124536.4200 $71.9600
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Subtotal (Total Children Is Unduplicated) 1011 5907 19511.442065 $1049572.0500 $53.7900
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Total 7198 61968.819823 $2059962.9200 $33.2400
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Number of Children (Unduplicated) With at Least One Authorization 1400