Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 52
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 2908 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 13 13 10.244445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 13 10.244445 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 3.000000 $185.1300 $61.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 3.000000 $48.4500 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 3.000000 $23.7600 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 3.000000 $95.4300 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 3.000000 $69.4200 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.493151 $112.9900 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.493151 $57.1200 $115.8200
OCTH -97165 OT EVAL LOW COMPLEXITY 21 22 21.233333 $1233.8700 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 19 20.733333 $1204.8100 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 20 22 28.000000 $1627.0800 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 10 10 11.800000 $685.7000 $58.1100
SCREEN-T1023 SCREENING 43 44 44.000000 $2375.1200 $53.9800
SPCH -92521 EVAL OF SPEECH FLUENCY 21 22 27.800000 $1615.4600 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 3.000000 $174.3300 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 10.000000 $581.1000 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 7 7.000000 $406.7700 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 29 37 180.504764 $10489.1300 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 12.857143 $747.1300 $58.1100
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Subtotal (Total Children Is Unduplicated) 152 208 387.914875 $21907.1200 $56.4700
EI Services, Class # 03
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1 1 0.400000 $20.0000 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 433 594 1710.585710 $85529.2700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 4.733333 $236.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 6.000000 $150.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 242 318 961.499996 $48074.9800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 3.000000 $75.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 142 218 746.333332 $37316.6600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 232 279 862.866665 $43143.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 17 18 59.300001 $1482.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 635 824 4260.086921 $230044.5100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 12.923810 $697.8900 $54.0000
INTR -T1013 INTERPRETER 3 3 19.952381 $997.6300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 84 109 396.895236 $32275.5000 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 2 3 12.209523 $992.8800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 11 11 47.266668 $3078.0100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 97 120 551.595243 $44855.7100 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 5 8 21.019047 $1709.2700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 16 23 110.542859 $7198.5500 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 1 2 12.857143 $837.2600 $65.1200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 1 1 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 121 148 759.861910 $61791.9200 $81.3200
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Subtotal (Total Children Is Unduplicated) 824 2687 10563.929778 $601234.6200 $56.9100
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Total 2908 10962.089098 $623141.7500 $56.8500
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Number of Children (Unduplicated) With at Least One Authorization 856