Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 4770 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 124 136 201.976191 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 124 136 201.976191 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 18.000000 $2084.5800 $115.8100
EXIT -EXIT COS Exit 174 178 144.785714 $7239.2900 $50.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 3 3 2.888888 $410.8700 $142.2300
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Subtotal (Total Children Is Unduplicated) 191 195 165.674602 $9734.7400 $58.7600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 53 64 150.161907 $10413.7600 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 4 4.455555 $308.9900 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 150 157 161.391587 $8069.5900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 62 65 63.891587 $3194.5800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 64 65 36.533069 $913.3300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 19 23 30.772224 $1538.6200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 9 12 15.016666 $750.8300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 13 14 24.038095 $600.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 14 17 25.311111 $1265.5600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 9 10 12.522222 $626.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 7.550000 $188.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 5 6 8.900001 $445.0100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 3.066667 $153.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 4 9.166666 $229.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 9 11 11.672221 $583.6100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 1 1 3.066667 $153.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 11.233334 $280.8400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 45 61 1222.857156 $30571.4000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 9 150.857143 $4073.1400 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 2.285714 $114.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1157 1572 12357.914277 $667328.1100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 81 93 662.809524 $35791.7700 $54.0000
INTR -T1013 INTERPRETER 69 97 767.971425 $38398.5600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1242 1753 13855.476176 $166265.9000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 32 45 284.600000 $23143.6800 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 5 7 22.607143 $1838.4200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 8 9 65.714286 $4279.3200 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 4 6 32.178571 $2095.4700 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 53 67 490.112698 $39856.0000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 10 13 57.735716 $4695.0500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 14 19 153.021429 $9964.7700 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 7 8 63.857143 $4158.3800 $65.1200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 2.000000 $229.6200 $114.8100
SENS -V5060 BEHIND EAR HEARING AID 13 13 15.000000 $3444.1500 $229.6100
SENS -V5264 EARMOLD 36 43 135.226985 $2451.6700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 101 125 995.638095 $80965.3700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 24 31 238.750000 $19415.1700 $81.3200
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Subtotal (Total Children Is Unduplicated) 1418 4439 32156.363060 $1173796.5600 $36.5000
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Total 4770 32524.013853 $1183531.3000 $36.3900
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Number of Children (Unduplicated) With at Least One Authorization 1507