Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 3150 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 15 15 12.955555 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 15 15 12.955555 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 6.800000 $419.6300 $61.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 5 11.200000 $180.8800 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 4 5 11.200000 $88.7000 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 5 11.200000 $356.2700 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 5 11.200000 $259.1700 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 6 3.756165 $170.2400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 3.260275 $377.5800 $115.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 15 15 15.000000 $871.6500 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 18 18.000000 $1045.9800 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 11 11 11.000000 $639.2100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 11 11.000000 $639.2100 $58.1100
SCREEN-T1023 SCREENING 47 49 49.000000 $2645.0200 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 26 26 32.133333 $1867.2700 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 13 16 16.000000 $929.7600 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 9 9.000000 $522.9900 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 28 35 195.161904 $11340.8600 $58.1100
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Subtotal (Total Children Is Unduplicated) 164 226 416.911677 $22470.6300 $53.9000
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3 3 11.200000 $560.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.500000 $12.5000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 438 633 1944.716682 $97235.9100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.400000 $20.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 275 332 1144.033334 $57201.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 9.200000 $230.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 148 224 862.733342 $43136.7100 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 239 298 932.366676 $46618.3800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 11 36.633334 $915.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 655 890 4884.688084 $263773.3200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 13 60.438095 $3263.6600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 103 126 659.461897 $53627.4100 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 0.266667 $21.6900 $81.3300
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 20.428571 $1661.2500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 5 5 22.895238 $1490.9400 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 10.857143 $707.0100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 106 125 640.583340 $52092.3200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 11 17 43.971428 $3575.7500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 24 29 187.619049 $12217.7600 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 2 3 14.428571 $939.5800 $65.1200
SENS -V5050 IN EAR MONAURAL HEARING AID 2 3 6.000000 $1377.6600 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 4.000000 $1836.8800 $459.2200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 2 2 2.000000 $1961.4800 $980.7400
SENS -V5264 EARMOLD 7 8 9.755553 $176.8600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 133 168 842.297609 $68495.6100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 4 31.819047 $2587.5300 $81.3200
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Subtotal (Total Children Is Unduplicated) 880 2909 12387.293660 $716664.2200 $57.8500
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Total 3150 12817.160892 $739134.8500 $57.6700
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Number of Children (Unduplicated) With at Least One Authorization 912