Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 7361 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 54 59 65.932539 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 54 59 65.932539 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 3 4 94.511111 $4583.7900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 48 52 45.877776 $2831.1100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 65 70 61.761107 $938.1400 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 82 87 74.249204 $1593.3800 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $26.0400 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 4.000000 $64.6000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 33 35 44.457142 $1079.4200 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 6 2.772223 $21.9600 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 40 42 41.220057 $1311.2000 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 124 139 94.516657 $1435.6900 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 65 69 84.962697 $1966.0300 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.027778 $2.1800 $78.3100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 0.027778 $2.2600 $81.3100
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 4.255556 $192.8600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 4.005555 $463.8800 $115.8100
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 1.000000 $59.9200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 6 6 11.142857 $667.6800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 8.142857 $659.4100 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $323.9200 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 36 52 48.588889 $2823.5000 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 85 97 66.944442 $3890.1300 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 0.472222 $27.4400 $58.1100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 2 1.022222 $59.4000 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 10 10 8.711111 $506.2000 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 4.022222 $233.7300 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 64 76 64.369047 $3740.4800 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 1.433333 $83.2900 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 3 3 2.322222 $134.9400 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 39 48 41.822222 $2430.2900 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 2.000000 $116.2200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 51 62 35.727775 $2076.1200 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.022222 $59.4000 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 7 4.650000 $270.2100 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 24 31 22.022221 $1279.7000 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 4 4 2.061111 $119.7700 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 1.322222 $76.8300 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 157 186 139.405554 $8100.8500 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 0.694445 $40.3600 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 12 13 17.000001 $987.8800 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 2.344444 $136.2300 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 2.000000 $116.2200 $58.1100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 2.000000 $116.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 176 195 149.053963 $8661.5000 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 6 7 4.633333 $269.2400 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 2.500000 $145.2800 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 5 7 4.588889 $266.6600 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 22 25 46.125397 $2680.3500 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 23 28 290.066667 $16855.8000 $58.1100
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Subtotal (Total Children Is Unduplicated) 896 1413 1555.856531 $74818.2700 $48.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 12 15 16.811111 $84055.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 3.933333 $272.7700 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.822222 $126.3700 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 19 20 36.122223 $8366.6500 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 243 314 282.092084 $14104.7000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 12 12 10.250000 $512.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 31.411904 $785.3000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 766 1054 2921.037328 $146051.9800 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 8 11 39.971428 $1998.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 6.133333 $153.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 397 516 1222.665094 $61133.3300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 9 12 20.766668 $1038.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.833333 $45.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 182 226 581.904768 $29095.2800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 3 3 5.433334 $271.6700 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 455 601 1328.484151 $66424.3300 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 11 11 27.200001 $1360.0100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 5.266667 $131.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1658 2179 19896.596760 $1074417.2700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 63 73 694.963489 $37528.0600 $54.0000
INTR -T1013 INTERPRETER 2 2 11.857143 $592.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 165 218 2003.138090 $162895.3000 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 8.285714 $539.5700 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $1068.7800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 123 166 1502.452380 $122179.5800 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 3 26.285714 $2137.5500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 26.285714 $1711.7200 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 1 1 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 2.000000 $918.4400 $459.2200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 2 2 4.566667 $4478.7500 $980.7500
SENS -V5264 EARMOLD 8 10 42.565873 $771.7200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 292 383 3078.247620 $250323.3000 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 22.857143 $1858.7500 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 24 26 315.409522 $20539.4700 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 5 5 102.857142 $6698.0500 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $1068.7800 $81.3200
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 1 1 3.000000 $195.3600 $65.1200
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Subtotal (Total Children Is Unduplicated) 1837 5889 34312.793667 $2106310.6400 $61.3900
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Total 7361 35934.582737 $2181128.9100 $60.7000
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Number of Children (Unduplicated) With at Least One Authorization 1889