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: 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 3677 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 19 19 26.049206 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 19 19 26.049206 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 4 4 4.511111 $527.0300 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 2 2 1.511111 $176.5400 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 204 250 227.495234 $11033.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 42 49 38.872223 $2398.8100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 7 8 3.461111 $52.5700 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.400000 $8.5800 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.272222 $7.0900 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.400000 $6.4600 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 70 77 64.255556 $1560.1300 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.400000 $3.1700 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 8 8 5.488888 $174.6000 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $99.1800 $49.5900
AUDE -92602 REPROGRAM COCHLEAR IMPLT <7 1 1 0.461111 $28.0000 $60.7300
AUDE -92651 AEP HEARING STATUS DETER I&R 3 3 17.736508 $1387.8800 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 52 54 23.544444 $1067.0300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 7 3.683334 $426.5700 $115.8100
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Subtotal (Total Children Is Unduplicated) 358 469 394.492853 $18957.1600 $48.0500
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 12 13 10.766666 $516.1500 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 2 2 1.222222 $58.5900 $47.9400
AACFIT-92609TLGT AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.022222 $49.0000 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 78 87 126.972218 $634859.0000 $4999.9800
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 9.857143 $683.5900 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 3.877778 $898.1800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 306 393 301.146030 $15057.2900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 21 22 22.444443 $1122.2200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 116 143 169.241270 $8462.0500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.238889 $11.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 268 297 396.685712 $19834.2200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 5 4.972223 $124.3100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 157 181 250.965874 $12548.2800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.000000 $100.0000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 343 414 498.805551 $24940.2400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 17 17 15.332539 $383.3100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 17 117.680951 $3177.4000 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 730 939 5742.298425 $310084.3500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 52 60 379.357143 $20485.3100 $54.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1 1 0.600000 $7.2000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 104 126 778.563494 $63312.8600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 6 6 25.307937 $2058.0400 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 6.428571 $522.7700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 13.142857 $1068.7800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 6 8 30.571429 $1990.8100 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 54 63 365.642861 $29734.1300 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 20 22 133.314286 $10841.1100 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 5.366667 $436.4200 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 13 13 96.714285 $6298.0400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 68 79 451.142860 $36687.0000 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 4 5 28.285714 $2300.2000 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 48 61 263.441270 $21423.0900 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 13.428571 $1092.0100 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 2 1.022223 $234.7300 $229.6300
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 9 10.461111 $4803.9500 $459.2200
SENS -V5264 EARMOLD 10 13 21.553968 $390.7700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 114 137 895.138091 $72792.6900 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 6 32.547618 $2646.7800 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 21 24 80.057141 $6510.2500 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 6 6 16.033333 $1303.8400 $81.3200
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Subtotal (Total Children Is Unduplicated) 1197 3189 11324.651586 $1319920.2500 $116.5500
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Total 3677 11745.193645 $1338877.4000 $113.9900
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Number of Children (Unduplicated) With at Least One Authorization 1212