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 1614 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 14 14 9.888888 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 14 14 9.888888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 3.066667 $49.5300 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 3.066667 $24.2900 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 3.066667 $97.5500 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 3.066667 $70.9600 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.252055 $11.4300 $45.3300
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.252055 $29.2000 $115.8300
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SCREEN-T1023 SCREENING 5 5 5.000000 $269.9000 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 4.000000 $232.4400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 9.857143 $572.8000 $58.1100
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Subtotal (Total Children Is Unduplicated) 16 21 36.627921 $1648.6400 $45.0100
EI Services, Class # 03
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 432 627 1934.850015 $96742.5800 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.400000 $20.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 269 326 1134.166667 $56708.3400 $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 43 60 286.257142 $15457.8800 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 8 9 61.895239 $5033.3100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 3 4 3.733334 $303.6000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 2 6.133333 $498.7600 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 1 1 1.022222 $18.5300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7 8 37.500000 $3049.5000 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 2 12.542857 $1019.9900 $81.3200
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Subtotal (Total Children Is Unduplicated) 530 1579 5332.134161 $270785.1300 $50.7800
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Total 1614 5378.650970 $272433.7700 $50.6500
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Number of Children (Unduplicated) With at Least One Authorization 544