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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2380 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 147 159 112.388888 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 147 159 112.388888 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 25 34 28.827777 $1398.1400 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 12 12 9.182039 $292.0800 $31.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.493150 $57.1200 $115.8200
OCTH -97165 OT EVAL LOW COMPLEXITY 2 3 0.622222 $36.1600 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 75 97 56.453967 $3280.5400 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 3.000000 $174.3300 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 89 109 55.927779 $3249.9700 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.472222 $27.4400 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.500000 $29.0600 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.094444 $5.4900 $58.0800
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 131 162 105.217455 $6114.1500 $58.1100
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Subtotal (Total Children Is Unduplicated) 292 427 261.791055 $14722.5800 $56.2400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 32 29.124353 $145622.0000 $5000.0100
AUDE -V5160 DISPENSING FEE BINAURAL 1 2 0.246575 $57.0900 $231.5500
CONIF -CONIF CONSULT, ITDS FACE TO FACE 23 24 48.660319 $2433.0200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 132 163 223.811117 $11190.5900 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 69 86 121.401589 $6070.0900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 134 162 240.796825 $12039.8400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 627 883 4775.885745 $257897.6800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 33.000000 $1781.9900 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 80 113 595.679370 $48440.6200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 98 134 809.869050 $65858.4700 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.493150 $113.2400 $229.6300
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 2 0.246575 $241.7500 $980.4400
SENS -V5264 EARMOLD 3 4 1.232876 $22.3500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 131 182 1032.414288 $83955.8500 $81.3200
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Subtotal (Total Children Is Unduplicated) 903 1794 7912.861832 $635724.5800 $80.3400
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Total 2380 8287.041775 $650447.1600 $78.4900
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Number of Children (Unduplicated) With at Least One Authorization 1026