Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 53
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 1883 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 31 35 43.973015 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 31 35 43.973015 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 26 31 27.561111 $1336.7100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.061111 $3.7700 $61.7000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 4 5 3.233333 $49.1100 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 110 120 70.688900 $1716.3500 $24.2800
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $54.9000 $54.9000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
EXIT -EXIT COS Exit 3 3 4.000000 $200.0000 $50.0000
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.600000 $209.2000 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 3 12.195238 $708.6700 $58.1100
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Subtotal (Total Children Is Unduplicated) 141 166 123.339693 $4324.0400 $35.0600
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 3 3.777778 $181.1100 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 27 38 35.605555 $178027.5000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 6 7 5.605555 $1298.3500 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 17 22 14.142857 $707.1500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 8 8 5.535714 $276.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 3.033333 $75.8300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6 7 14.940476 $747.0200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 78 84 154.834921 $7741.7500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.055556 $2.7800 $50.0400
CONPF -CONPF CONSULT, PT, FACE TO FACE 63 72 120.180950 $6009.0300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 104 120 230.613491 $11530.6800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 4.200000 $210.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 8.283332 $207.0800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 4.571429 $228.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 454 560 3523.477007 $190267.7900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 37 42 212.014286 $11448.7800 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 171 238 1499.860321 $17998.3300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 76 91 640.690477 $52101.0000 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 26.000000 $2114.3200 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 63 74 556.042864 $45217.4100 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 21.704763 $1765.0300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 44 56 409.119049 $33269.5700 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 4 9.066667 $737.3000 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 32 37 247.606349 $20135.3400 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 30.333333 $2466.7000 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.011111 $464.3200 $459.2100
SENS -V5264 EARMOLD 1 1 1.011111 $18.3300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 78 98 587.539684 $47778.7100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 14.638095 $1190.3600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 80 91 514.696829 $41855.1600 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 32.128572 $2612.7100 $81.3200
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Subtotal (Total Children Is Unduplicated) 844 1682 8932.321465 $678684.7700 $75.9800
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Total 1883 9099.634173 $683008.8100 $75.0600
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Number of Children (Unduplicated) With at Least One Authorization 867