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 4047 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 1 1 0.511111 $24.7900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 5.022222 $309.9200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 14 14 13.011109 $197.6400 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 14 14 18.249206 $391.6300 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $32.3000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 0.922222 $22.3900 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 0.722223 $5.7200 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 4.344444 $138.2000 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 20 22 14.966665 $227.3400 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 13 13 34.873809 $806.9800 $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
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 1 1 2.000000 $119.8400 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 12 11.066667 $643.0900 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 23 26 18.594443 $1080.5100 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.511111 $29.7000 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 10 11 13.480159 $783.3300 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 15 19 17.655555 $1025.9600 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 9 9 6.600000 $383.5300 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.022222 $59.4000 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 1.627778 $94.5900 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 5 5 3.133333 $182.0800 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 33 39 30.761111 $1787.5300 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.344444 $20.0100 $58.1000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 35 36 30.800000 $1789.7900 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $29.7000 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 1.077778 $62.6300 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $174.3300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 4 36.638095 $2129.0500 $58.1100
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Subtotal (Total Children Is Unduplicated) 172 261 277.502374 $12790.6400 $46.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 5 5 3.811111 $19055.5000 $4999.9900
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 2.933333 $203.4200 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 9.000000 $2084.5800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 242 313 281.892084 $14094.7000 $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 395 514 1219.398427 $60970.0000 $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 454 600 1326.684151 $66334.3300 $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 615 780 6947.782515 $375180.6400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 5 28.238096 $1524.8600 $54.0000
INTR -T1013 INTERPRETER 2 2 11.857143 $592.8600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 34 43 407.671424 $33151.8900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 26 31 330.428567 $26870.5100 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 8.857143 $720.2600 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 26.285714 $1711.7200 $65.1200
SENS -V5264 EARMOLD 1 1 3.000000 $54.3900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 57 72 513.923816 $41792.2900 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 7 94.571428 $6158.4900 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 3 3 61.714285 $4018.8400 $65.1200
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Subtotal (Total Children Is Unduplicated) 1192 3727 14929.258001 $835963.7300 $55.9900
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Total 4047 15272.692914 $848754.3700 $55.5700
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Number of Children (Unduplicated) With at Least One Authorization 1248