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: 04-01-24 and 06-30-24 Date of Report: 04-12-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2076 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 46 47 59.107143 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.033333 $38.4400 $37.2000
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Subtotal (Total Children Is Unduplicated) 47 48 60.140476 $38.4400 $0.6400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 29 33 28.466668 $1380.6400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 1.794445 $110.7400 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 5 3.088889 $46.9200 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 131 137 82.716677 $2008.3900 $24.2800
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $54.9000 $54.9000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.988889 $90.1400 $45.3200
EXIT -EXIT COS Exit 2 2 2.000000 $100.0000 $50.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 1.500000 $121.4700 $80.9800
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.500000 $89.8800 $59.9200
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 23.780953 $1381.9100 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 3 20.495239 $1190.9800 $58.1100
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Subtotal (Total Children Is Unduplicated) 171 190 168.331760 $6575.9600 $39.0700
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.000000 $47.9400 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 33 46 42.194446 $210973.0000 $5000.0200
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 4.638889 $1074.4600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 23 32 20.250000 $1012.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 2 3 2.000000 $100.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 2.700000 $67.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 9 9 15.211904 $760.6000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 91 107 207.230948 $10361.5200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 1.011111 $50.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 7.883334 $197.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 85 98 154.607144 $7730.3700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 115 136 242.473019 $12123.6600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 1.133333 $56.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 13 15 18.561112 $464.0300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 524 643 4068.603988 $219704.5700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 32 34 200.614289 $10833.1800 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 136 180 1058.323817 $12699.8800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 82 92 595.964291 $48463.8300 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 15.714286 $1277.8900 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 71 87 557.197624 $45311.3300 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 17.200000 $1398.7000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 57 68 497.476192 $40454.7600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 8.266667 $672.2500 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 30 40 228.590478 $18588.9600 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 2 3 15.714286 $1277.8900 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.922222 $423.4900 $459.2100
SENS -V5264 EARMOLD 4 5 0.455556 $8.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 88 106 615.396829 $50044.1000 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 7 39.776191 $3234.5900 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 77 97 552.076193 $44894.8100 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 29.047619 $2362.1500 $81.3200
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Subtotal (Total Children Is Unduplicated) 930 1838 9222.235768 $746670.5400 $80.9600
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Total 2076 9450.708004 $753284.9400 $79.7100
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Number of Children (Unduplicated) With at Least One Authorization 967