Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 11249 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 7 7 2.577779 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 7 7 2.577779 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 3.000000 $45.5700 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 967 1009 1009.000000 $21653.1400 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 876 907 907.000000 $14648.0500 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $24.2800 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 870 901 901.000000 $7135.9200 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 869 900 900.000000 $28629.0000 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $15.1900 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 871 902 901.122222 $20851.9700 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 4.000000 $181.2800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 3.000000 $347.4300 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 18 20 30.288888 $1514.4400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 100 125 130.420635 $7578.7500 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 29 30 29.455556 $1711.6600 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 151 176 173.766667 $10097.5800 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 14.285715 $830.1400 $58.1100
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Subtotal (Total Children Is Unduplicated) 1168 4986 5009.339683 $115322.5100 $23.0200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 25 27.428571 $137143.0000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2 2 2.000000 $100.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 438 603 755.823807 $37791.1900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 88 108 162.915879 $8145.8200 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 126 147 162.671427 $8133.5600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 316 412 515.903178 $25795.1800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 5.857143 $292.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1705 2405 19436.803549 $1049588.1500 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 502 713 4932.310351 $401095.4400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 573 844 4932.730991 $401129.4800 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 2.000000 $459.2200 $229.6100
SENS -V5264 EARMOLD 4 4 4.000000 $72.5200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 697 987 6382.962730 $519062.5100 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 6.285714 $511.1500 $81.3200
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Subtotal (Total Children Is Unduplicated) 2478 6256 37330.693340 $2589434.8800 $69.3600
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Total 11249 42342.610802 $2704757.3900 $63.8800
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Number of Children (Unduplicated) With at Least One Authorization 2524