Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 6712 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 51 56 55.976982 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 51 56 55.976982 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 69 73 59.357936 $3662.9800 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 71 74 72.549205 $1102.0200 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 48 52 41.262696 $885.4900 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 15.329365 $399.1800 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 5.142857 $83.0600 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 27 31 29.006348 $704.2700 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 8 8 9.448413 $74.8300 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 32 35 68.270028 $2171.6700 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.000000 $99.1800 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 92 101 67.344441 $1022.9600 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 70 76 61.105557 $1413.9900 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 6.200000 $280.9800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.088889 $10.3000 $115.8200
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.011111 $0.6700 $59.8600
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.011111 $0.9000 $80.9000
OCTF -97168 OT RE-EVAL EST PLAN CARE 29 36 34.133334 $1983.4900 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 89 102 61.016664 $3545.6600 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 5 7 2.211111 $128.4900 $58.1100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 8 5.000000 $290.5500 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 2.688889 $156.2500 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 36 44 30.683333 $1783.0100 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.500000 $29.0600 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 5 5 5.000000 $290.5500 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.238889 $13.8800 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 26 33 30.094444 $1748.7900 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 57 73 42.438890 $2466.1300 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.400000 $139.4600 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.294444 $17.1100 $58.1000
PSTH -97163 PT EVAL HIGH COMPLEXITY 23 32 21.988888 $1277.7700 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 0.705556 $41.0000 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 0.277778 $16.1400 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 173 208 154.608732 $8984.3200 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 4 4 2.900000 $168.5200 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.261111 $15.1700 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 20 22 22.088888 $1283.5800 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 4.000000 $232.4400 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.355556 $20.6600 $58.1200
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.144444 $8.3900 $58.0900
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 92 109 79.088889 $4595.8600 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $174.3300 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 1.533333 $89.1000 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 3.916667 $227.6000 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 29 35 36.496032 $2120.7800 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 4.000000 $232.4400 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 33 43 425.940478 $24751.3900 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 7.714286 $448.2800 $58.1100
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Subtotal (Total Children Is Unduplicated) 789 1265 1433.848593 $69871.6300 $48.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 10 10 11.927778 $59639.0000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.133333 $9.2400 $69.3300
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.200000 $13.8700 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 15 15 26.716666 $6188.1000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 217 292 274.346043 $13717.3600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 20 26 22.600000 $1130.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 25 28 26.888890 $672.2300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 707 981 2986.209519 $149310.4600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 16 19 38.271428 $1913.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 6.166667 $154.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 347 462 1147.877780 $57393.9000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 12 14 23.966667 $1198.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 5 6 6.233333 $155.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 163 222 535.566665 $26778.3300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 4 5 11.700000 $585.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 2.433334 $60.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 393 515 1236.323015 $61816.1500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 8 10 18.733333 $936.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 9.766666 $244.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1519 1954 17914.554091 $967385.1100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 90 112 856.700000 $46261.7600 $54.0000
INTR -T1013 INTERPRETER 2 2 20.428571 $1021.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 123 165 1581.285723 $128590.0600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 4 4 40.571429 $3299.2700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 25.142857 $2044.6200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 22 26 205.609526 $13389.2900 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 2 12.857143 $837.2500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 106 152 1347.314297 $109563.4400 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 25.714286 $1674.5200 $65.1200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 7.571429 $615.7100 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 2.000000 $459.2200 $229.6100
SENS -V5260 IN EAR DIGITAL BINAURAL HEARING AID 1 1 0.366667 $365.2700 $996.1800
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.533333 $523.0300 $980.6800
SENS -V5264 EARMOLD 5 6 17.234921 $312.4700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 233 303 2581.602403 $209935.6800 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 13.857143 $1126.8600 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 20 26 253.571430 $16512.5800 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 6 7 63.285714 $4121.1600 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 14.571429 $1184.9500 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 7.714286 $627.3300 $81.3200
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 2 2 23.428572 $1525.6600 $65.1200
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Subtotal (Total Children Is Unduplicated) 1688 5391 31401.976367 $1893293.8500 $60.2900
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Total 6712 32891.801942 $1963165.4700 $59.6900
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Number of Children (Unduplicated) With at Least One Authorization 1737