Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 09
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 5290 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 50 51 83.617465 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 50 51 83.617465 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 5 3.127779 $67.1200 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 5 3.127779 $81.4500 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 5 3.127779 $50.5200 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 5 3.127779 $24.7700 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 5 3.127779 $99.5000 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 5 3.127779 $72.3800 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 3 5 3.127779 $244.7600 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 2.022223 $91.6500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 2.022223 $234.2000 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 12 14 85.599999 $4280.0100 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 46 54 343.252382 $17162.6600 $50.0000
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 47 68 506.428570 $29428.6100 $58.1100
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Subtotal (Total Children Is Unduplicated) 104 180 965.219850 $52070.0800 $53.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 4.850000 $24250.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 262 420 599.040347 $29952.0400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 109 133 126.088742 $3152.2300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 332 377 316.109518 $15805.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 1.350000 $33.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 193 208 179.694444 $8984.7200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.000000 $25.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 117 126 101.216664 $5060.8200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.350000 $33.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 213 232 212.838886 $10641.9300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.000000 $25.0000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 0.428571 $21.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1680 2378 18569.557127 $1002757.2100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 218 287 2034.157144 $165417.8600 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.833333 $67.7600 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 25 29 207.428573 $13507.7700 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 253 357 2752.743648 $223853.3300 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.105556 $12.1200 $114.8600
SENS -V5050 IN EAR MONAURAL HEARING AID 2 3 2.022223 $464.3400 $229.6200
SENS -V5264 EARMOLD 3 5 3.127779 $56.7100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 370 487 3919.907145 $318767.1300 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 35.714286 $2325.7200 $65.1200
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Subtotal (Total Children Is Unduplicated) 1977 5059 29070.563986 $1825216.0600 $62.7900
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Total 5290 30119.401301 $1877286.1300 $62.3300
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Number of Children (Unduplicated) With at Least One Authorization 2015