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 2232 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 21 21 17.303174 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 21 21 17.303174 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 243 307 270.066665 $13098.2300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 12 12 10.227778 $631.1600 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 1.533333 $23.2900 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.511111 $10.9700 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.511111 $8.2500 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 10 10 9.522221 $231.2000 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.511111 $4.0500 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 6 3.044444 $96.8400 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $99.1800 $49.5900
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 13.509524 $1057.1300 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 1.588888 $72.0000 $45.3200
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Subtotal (Total Children Is Unduplicated) 269 351 314.026186 $15449.1300 $49.2000
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 6 6 4.455555 $213.6000 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.377778 $18.1100 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 79 91 135.638888 $678194.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.511111 $118.3800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 304 375 285.071028 $14253.5400 $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 4 4 11.928572 $322.0700 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 119 145 849.203182 $45856.9500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 10 86.714286 $4682.5800 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 14 15 39.288889 $471.4700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 19 26 133.861906 $10885.6700 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 0.244444 $19.8700 $81.3100
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 8.166667 $664.1200 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 8.704762 $707.8700 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 1 1 1.000000 $81.3200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 17 21 126.966665 $10324.9300 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 2 3 9.566666 $777.9600 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.022222 $469.4100 $459.2100
SENS -V5264 EARMOLD 3 3 3.111110 $56.4000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 37 45 186.493656 $15165.6400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.142857 $92.9400 $81.3200
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Subtotal (Total Children Is Unduplicated) 795 1860 3287.274991 $852585.5500 $259.3600
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Total 2232 3618.604351 $868034.6700 $239.8800
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Number of Children (Unduplicated) With at Least One Authorization 828