Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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 2672 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 163 181 126.417445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 163 181 126.417445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 31 40 36.133334 $1752.4700 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 5 5.022222 $159.7600 $31.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 1.803044 $208.8200 $115.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 10 13 7.261111 $421.9400 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 64 79 51.126656 $2970.9600 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 98 138 78.885717 $4584.0700 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.511111 $29.7000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.511111 $29.7000 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 168 201 122.497618 $7118.3300 $58.1100
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Subtotal (Total Children Is Unduplicated) 319 487 307.751924 $17508.1800 $56.8900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 28 35 31.869102 $159345.5000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.167123 $38.7000 $231.5900
CONIF -CONIF CONSULT, ITDS FACE TO FACE 24 28 37.633335 $1881.6800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 109 136 206.258734 $10312.9700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 92 121 147.938887 $7396.9400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 162 207 272.983344 $13649.2200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 3.266667 $163.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 619 944 4874.179348 $263205.8900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 3 26.285714 $1419.4300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 72 106 531.780944 $43244.4100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 110 171 878.680947 $71454.3300 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 0.780822 $179.3000 $229.6300
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.167123 $163.8800 $980.6100
SENS -V5264 EARMOLD 6 6 1.534247 $27.8200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 174 240 1266.144438 $102962.9000 $81.3200
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Subtotal (Total Children Is Unduplicated) 925 2004 8279.670775 $675446.3000 $81.5800
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Total 2672 8713.840144 $692954.4800 $79.5200
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Number of Children (Unduplicated) With at Least One Authorization 1071