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 2996 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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 7 7 2.577779 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 67 72 72.000000 $1545.1200 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 52 56 56.000000 $904.4000 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 52 56 56.000000 $443.5200 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 52 56 56.000000 $1781.3600 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 52 56 56.000000 $1295.8400 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 18 19 27.955555 $1397.7800 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 18 24 24.000000 $1394.6400 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 6 5.566667 $323.4800 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 32 33 33.000000 $1917.6300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $207.5300 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 132 381 392.093651 $11372.4300 $29.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 4 4.000000 $20000.0000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 1.000000 $50.0000 $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 1 1 4.571429 $228.5700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 634 849 7008.951968 $378483.6900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 101 123 843.657938 $68606.2400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 115 150 948.892862 $77163.9600 $81.3200
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 173 209 1526.250006 $124114.6500 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1191 2608 11935.638494 $748530.9900 $62.7100
-------------------------------------------------------------------------------------------------------------------------------------
Total 2996 12330.309924 $759903.4200 $61.6300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1210