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: 01-01-24 and 03-31-24 Date of Report: 04-04-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 5436 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 130 151 99.986501 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 130 151 99.986501 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 0.505556 $24.5200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 11 11.000000 $678.8100 $61.7100
OCTH -97165TL OT EVAL LOW COMPLEXITY 3 3 0.300000 $17.4300 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 3 3 1.144445 $66.5100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 0.350000 $20.3400 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 125 162 56.100014 $3260.0500 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.505556 $29.3800 $58.1200
PSTH -97161TL PT EVAL LOW COMPLEXITY 4 5 1.450000 $84.2600 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.133333 $7.7500 $58.1000
PSTH -97163TL PT EVAL HIGH COMPLEXITY 99 131 38.451151 $2234.4500 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 2.000000 $30.2200 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 2 0.505556 $29.3800 $58.1200
SPCH -92521TL EVAL OF SPEECH FLUENCY 107 143 36.122232 $2099.1200 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.133333 $7.7500 $58.1000
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.011112 $58.7600 $58.1200
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 1.938890 $112.6800 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 45.571429 $2648.1500 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 4 4 38.142857 $2216.4800 $58.1100
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Subtotal (Total Children Is Unduplicated) 248 482 235.365464 $13626.0400 $57.8900
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.505556 $35.0600 $69.3600
AUDE -V5160 DISPENSING FEE BINAURAL 8 9 9.000000 $2084.5800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 52 145 42.613902 $2130.7600 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 18 20 16.412698 $820.6300 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 15 12.217460 $610.8700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.677778 $16.9500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 10 6.466666 $323.3300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 9 9 7.974604 $398.7300 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 156 252 1664.285712 $44935.7400 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1338 1818 14890.392078 $804081.2100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 13 14 108.428571 $5855.1400 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1342 1833 15096.397635 $181156.7700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 3 3 18.142858 $1475.3700 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 184 251 1585.373814 $128922.6100 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 12.428571 $1010.6900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 2 2 26.000000 $2114.3200 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 141 198 1201.714289 $97723.3900 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 3.000000 $1377.6600 $459.2200
SENS -V5264 EARMOLD 3 5 5.000000 $90.6500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 8.714285 $708.6500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 152 211 1131.533334 $92016.3000 $81.3200
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Subtotal (Total Children Is Unduplicated) 1571 4803 35847.279811 $1367889.4100 $38.1600
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Total 5436 36182.631776 $1381515.4500 $38.1800
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Number of Children (Unduplicated) With at Least One Authorization 1645