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 3851 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
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 15.041269 $928.1900 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 15 15 12.005555 $182.3600 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 10 11 10.223808 $219.4000 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 13.329365 $347.1000 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 3.142857 $50.7600 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 5 2.255555 $54.7600 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 4.009524 $31.7600 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 5 7.731746 $245.9500 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 25 26 19.216665 $291.9000 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 4.522222 $104.6400 $23.1400
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 10 10.266667 $596.6000 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 21 26 14.422222 $838.0700 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 9 11 5.994444 $348.3300 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 10 12 11.500000 $668.2700 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 16 21 14.300000 $830.9700 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.400000 $139.4600 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 3 4 1.533333 $89.1000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 48 59 40.123809 $2331.5900 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 2.000000 $116.2200 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 2.000000 $116.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 20 21 17.794444 $1034.0300 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.416667 $24.2100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 4 4.000000 $232.4400 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 5 6 52.511905 $3051.4600 $58.1100
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Subtotal (Total Children Is Unduplicated) 175 266 279.742057 $13400.4100 $47.9000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 3 3 1.661111 $8305.5000 $4999.9700
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.133333 $9.2400 $69.3300
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 10.000000 $2316.2000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 216 291 274.146043 $13707.3600 $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 345 460 1143.444447 $57172.2300 $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 572 735 6871.211162 $371045.0900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 19 22 118.219049 $6383.8200 $54.0000
INTR -T1013 INTERPRETER 2 2 20.428571 $1021.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 31 39 387.571432 $31517.2800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 3 3 13.428571 $874.4700 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 30 37 362.047622 $29441.6600 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 1 25.714286 $1674.5200 $65.1200
SENS -V5264 EARMOLD 1 1 2.111111 $38.2700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 61 77 637.857149 $51870.4900 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.000000 $81.3200 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 8 110.000000 $7163.2100 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 4 4 16.000000 $1041.9200 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.714286 $139.4100 $81.3200
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Subtotal (Total Children Is Unduplicated) 1095 3529 14921.547690 $828759.1400 $55.5400
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Total 3851 15257.266729 $842159.5500 $55.2000
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Number of Children (Unduplicated) With at Least One Authorization 1141