Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 2229 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 5 5 2.277779 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 2.277779 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 57 58 58.000000 $1244.6800 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 54 55 55.000000 $888.2500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 54 55 55.000000 $435.6000 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 54 55 55.000000 $1749.5500 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 54 55 55.000000 $1272.7000 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.000000 $90.6400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.000000 $115.8100 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 15 16 26.161112 $1308.0600 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 14 17 17.000000 $987.8700 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.211111 $70.3800 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 22 25 25.000000 $1452.7500 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 12.857143 $747.1300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 5.571429 $323.7500 $58.1100
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Subtotal (Total Children Is Unduplicated) 104 344 368.800795 $10687.1700 $28.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 6 6.000000 $30000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 325 398 635.998415 $31799.9200 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 75 91 142.566666 $7128.3300 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 62 71 84.584128 $4229.2200 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 236 276 397.527780 $19876.4000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 585 738 6208.263518 $335245.9300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 66 78 634.392858 $51588.7800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 76 92 673.495233 $54768.6300 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 2.000000 $229.6200 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 2 2 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 104 125 1007.357147 $81918.2500 $81.3200
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Subtotal (Total Children Is Unduplicated) 925 1880 9795.185745 $617050.9400 $63.0000
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Total 2229 10166.264319 $627738.1100 $61.7500
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Number of Children (Unduplicated) With at Least One Authorization 940