Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 11330 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 176 194 282.314288 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 176 194 282.314288 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 63 82 89.204067 $4326.4200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 6 6.000000 $370.2600 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 10 11 18.618254 $282.8100 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 3.000000 $72.8400 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.000000 $7.9200 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.8800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $31.8100 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $15.1900 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $23.1400 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 3.066667 $168.3600 $54.9000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.000000 $90.6400 $45.3200
EXIT -EXIT COS Exit 144 149 108.307635 $5415.3700 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 3 6.000000 $359.5200 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 14.000000 $1133.7200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 11.000000 $890.7800 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 8 16.000000 $1295.6800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 6 6 12.000000 $971.7600 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 36 38 75.000000 $4494.0000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 15 16 31.000000 $1857.5200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 28 32 63.000000 $5101.7400 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 10 11 22.000000 $1781.5600 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 4.000000 $232.4400 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.1100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 7.000000 $406.7700 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.100000 $5.8100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 8.857143 $514.6900 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 13.142857 $763.7300 $58.1100
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Subtotal (Total Children Is Unduplicated) 308 415 539.296623 $32080.7400 $59.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 27 34 36.051577 $180258.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 2.566667 $178.0000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 12.571429 $2911.7900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 401 453 506.097342 $25304.8700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 58 65 56.827858 $2841.3800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 46 47 57.204111 $1430.1100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 574 705 1625.178598 $81259.0600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 47 56 101.953179 $5097.6800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 13.750000 $343.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 223 271 617.581754 $30879.1300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 22 24 77.557146 $3877.8800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 9 11 21.433334 $535.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 231 280 581.133339 $29056.7000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 25 26 49.200002 $2460.0100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 6 7 13.600000 $340.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 365 455 982.892874 $49144.7200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 31 36 51.282543 $2564.1400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 18 19 37.216666 $930.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 158 191 1480.642860 $79954.7900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 75 92 719.023805 $38827.3300 $54.0000
INTR -T1013 INTERPRETER 235 316 794.280951 $39714.0700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2330 3720 27505.005087 $330060.4100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 15 18 124.295239 $10107.6900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 31 35 257.057144 $20903.8900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 4 5 30.857143 $2509.3100 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 0.571429 $46.4700 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 2 3 3.000000 $54.3900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 42 55 414.228571 $33685.1100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 26.142857 $2125.9400 $81.3200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.857143 $446.5300 $65.1200
TRAN -TRAN *FAMILY TRANSPORTATION 1 1 2.000000 $200.0000 $100.0000
TRAV -TRAVS Travel by mile 2355 3778 27566.427308 $12267.0900 $0.4500
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Subtotal (Total Children Is Unduplicated) 2464 10721 63778.487956 $991189.4400 $15.5400
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Total 11330 64600.098867 $1023270.1800 $15.8400
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Number of Children (Unduplicated) With at Least One Authorization 2587