Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 3791 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 22 22 17.980952 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 22 17.980952 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 4 4 4.111111 $480.3000 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 2 3 1.511111 $176.5400 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 249 315 282.815872 $13716.5600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 40 42 34.083333 $2103.2800 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 9 9 5.383332 $81.7700 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.511111 $10.9700 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.177778 $4.6300 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.511111 $8.2500 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 75 81 67.077776 $1628.6400 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.511111 $4.0500 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.255556 $2.7800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 8 9 5.500000 $174.9600 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $99.1800 $49.5900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $23.1400 $23.1400
AUDE -92602 REPROGRAM COCHLEAR IMPLT <7 1 2 0.511111 $31.0400 $60.7300
AUDE -92651 AEP HEARING STATUS DETER I&R 4 4 20.390477 $1595.5600 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 53 55 22.955550 $1040.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 2.638888 $305.6000 $115.8100
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Subtotal (Total Children Is Unduplicated) 399 537 451.945228 $21487.5800 $47.5400
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 18 19 11.577776 $555.0300 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 3 3 0.938889 $45.0100 $47.9400
AACFIT-92609TLGT AAC FITTING, ADJUST, TRAINING VISIT 1 2 1.022222 $49.0000 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 107 127 181.346822 $906732.5000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.511111 $118.3800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 304 376 286.071028 $14303.5400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 25 28 29.261904 $1463.1000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 114 150 167.386508 $8369.3200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.005556 $0.2800 $50.4000
CONIP -CONIP CONSULT, ITDS PHONE 1 2 1.155556 $28.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 255 297 449.292060 $22464.5200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 6.563492 $328.1800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 2.822222 $70.5600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 144 174 205.073007 $10253.5800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 0.777778 $38.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 348 430 516.193651 $25809.6100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 15 17 15.273013 $381.8200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 22 117.757142 $3179.4400 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 715 943 5622.020678 $303589.1900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 34 41 318.642860 $17206.7300 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 14 15 39.288889 $471.4700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 112 152 763.068257 $62052.7700 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 2 0.673015 $54.7300 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 20.452382 $1663.1900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 3 3 7.000000 $455.8400 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 65 78 463.457143 $37688.3500 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 2 2 3.000000 $243.9600 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 5 5 13.500001 $879.1100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 66 81 427.922222 $34798.6500 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 26.285714 $2137.5600 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 48 64 353.985719 $28786.1200 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.022222 $234.7100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 5 4.505555 $2069.0200 $459.2100
SENS -V5264 EARMOLD 9 11 16.303173 $295.5700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 105 138 765.598421 $62258.4800 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 6.857143 $557.6300 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.714286 $46.5200 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 18 21 108.304763 $8807.3500 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 5 15.942858 $1296.4700 $81.3200
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Subtotal (Total Children Is Unduplicated) 1145 3232 10971.575038 $1559785.0300 $142.1700
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Total 3791 11441.501218 $1581272.6100 $138.2000
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Number of Children (Unduplicated) With at Least One Authorization 1157