Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 57
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 13548 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 17 17 37.466668 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 150 164 179.169045 $6665.0800 $37.2000
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Subtotal (Total Children Is Unduplicated) 167 181 216.635713 $6665.0800 $30.7700
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 5 5.000000 $79.2000 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 5.000000 $97.5500 $19.5100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.200000 $26.4800 $22.0700
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $28.9200 $28.9200
AUDE -V5010 ASSESSMENT FOR HEARING AID 94 104 103.355556 $4684.0800 $45.3200
OCTF -97168 OT RE-EVAL EST PLAN CARE 143 237 170.260322 $8753.1000 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 1 2 2.000000 $102.8200 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 5.866666 $301.6000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 178 179 177.019050 $9100.5600 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.816667 $41.9900 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 4 4 2.316666 $119.1000 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 59 101 68.174605 $3504.8700 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 67 68 84.772222 $4358.1400 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 4 4 2.866667 $147.3800 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.222222 $11.4200 $51.4000
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 294 538 442.905561 $22769.8000 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 1.571429 $80.7900 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 38 59 33.377781 $1715.9700 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 10 16 11.933335 $613.5000 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 2 31.857143 $1637.7800 $51.4100
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Subtotal (Total Children Is Unduplicated) 571 1341 1153.515892 $58277.8500 $50.5200
EI Services, Class # 03
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 2 2 2.000000 $100.0000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.855556 $59.3400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 14.571429 $3375.0300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 4 2.050000 $102.5000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 1 6 3.311112 $165.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1611 2545 4531.473779 $226573.5600 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 193 335 903.866666 $45193.3000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1855 2849 4466.581703 $223328.8600 $50.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 56.285713 $1407.1500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 188 460 4674.314262 $116857.8500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 9 145.852380 $7292.6300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2451 4115 61068.819036 $3053441.2700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 2 10.285715 $514.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 15 15 181.571428 $2178.8600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 258 550 4632.886513 $333382.5800 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 2 37.142857 $2672.8000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 5 10 37.490475 $2159.4500 $57.6000
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 20.285714 $1168.4600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 109 272 2181.214286 $156960.2300 $71.9600
PHY -97110HM PT SESSION BY PT ASST 4 6 33.571429 $1932.3600 $57.5600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 363 746 7336.984115 $527969.6000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.571429 $400.9200 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.285714 $189.2600 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 2 30.285715 $1744.4600 $57.6000
TRAV -TRAVS Travel by mile 52 85 1209.396826 $538.1800 $0.4500
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Subtotal (Total Children Is Unduplicated) 2538 12026 91589.953852 $4709708.4500 $51.4200
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Total 13548 92960.105457 $4774651.3900 $51.3600
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Number of Children (Unduplicated) With at Least One Authorization 2586