Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-24 and 12-31-24 Date of Report: 03-31-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2588 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 163 174 125.374594 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 163 174 125.374594 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 28 38 34.661111 $1681.0600 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 9 10 6.918797 $220.0900 $31.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 0.409589 $47.4200 $115.7800
OCTH -97165 OT EVAL LOW COMPLEXITY 5 6 2.122222 $123.3200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 73 93 61.126909 $3552.0900 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 3.305556 $192.0900 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 103 127 68.916665 $4004.7400 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 2 0.511111 $29.7000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.344445 $20.0200 $58.1200
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 149 194 108.853966 $6325.4900 $58.1100
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Subtotal (Total Children Is Unduplicated) 321 482 288.170371 $16254.1300 $56.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 28 37 29.302056 $146511.0000 $5000.0200
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.252055 $58.3900 $231.6600
CONIF -CONIF CONSULT, ITDS FACE TO FACE 24 25 36.755557 $1837.7900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 119 145 224.079373 $11204.0100 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 84 96 160.877779 $8043.9000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 154 186 299.111112 $14955.5600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 625 932 5139.393606 $277527.5600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 4 5 38.142857 $2059.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 76 110 628.520627 $51111.3400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 115 161 887.475393 $72169.5900 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 0.153425 $35.2200 $229.5700
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.252055 $247.2400 $980.9200
SENS -V5264 EARMOLD 4 5 1.090411 $19.7700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 154 225 1171.836496 $95293.7700 $81.3200
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Subtotal (Total Children Is Unduplicated) 934 1932 8617.242802 $681074.8500 $79.0400
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Total 2588 9030.787767 $697328.9900 $77.2200
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Number of Children (Unduplicated) With at Least One Authorization 1076