Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 3664 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 22 26 25.471429 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 26 25.471429 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 8 8 7.644445 $893.1100 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 2 2 1.222222 $142.7900 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 148 187 159.307145 $7726.4000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 34 38 31.883334 $1967.5200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 6 2.605556 $39.5800 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $21.4600 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $26.0400 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $32.3000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 69 76 61.694444 $1497.9400 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 2.000000 $15.8400 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 7 5.772222 $183.6100 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 3.455556 $171.3600 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.000000 $30.3800 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 2.122222 $49.1100 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 7.226985 $565.5100 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 51 56 25.272222 $1145.3400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 3.200000 $370.5900 $115.8100
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Subtotal (Total Children Is Unduplicated) 290 403 319.406353 $14878.8900 $46.5800
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 20 21 12.305555 $589.9300 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.000000 $47.9400 $47.9400
AACFIT-92609TLGT AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.444444 $21.3000 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 66 78 112.838889 $564194.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 12.857143 $891.6400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 5.688889 $1317.6600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 321 393 334.583729 $16729.1800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 13 15 14.538889 $726.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.272222 $6.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 130 169 178.758726 $8937.9300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 2 2 1.500000 $75.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 258 295 345.233335 $17261.6900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 4 5 2.933333 $73.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 169 204 251.873021 $12593.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 343 421 455.507925 $22775.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 18 10.808730 $270.2200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 11 149.142859 $4026.8500 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 719 952 5525.282555 $298365.0300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 57 67 415.428573 $22433.1200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 95 112 690.776196 $56173.9200 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 8 8 38.199999 $3106.4200 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 2 6.428571 $522.7700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 3 4 22.928572 $1864.5500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 18 20 90.676189 $5904.8300 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 45 53 302.030158 $24561.0900 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 25 29 224.119048 $18225.3500 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 3.000000 $243.9600 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 14 18 104.500000 $6805.0300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 58 72 350.119048 $28471.6800 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 1.142857 $92.9400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 3 32.142857 $2613.8500 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 40 53 217.701586 $17703.4500 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 31.000000 $2520.9100 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.200000 $45.9200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 8 10.000000 $4592.2000 $459.2200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 1.000000 $980.7400 $980.7400
SENS -V5264 EARMOLD 8 10 34.147619 $619.0900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 98 124 715.065084 $58149.0100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 9 62.071428 $5047.6500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 28 34 120.653969 $9811.5700 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 6 6 34.428572 $2799.7300 $81.3200
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Subtotal (Total Children Is Unduplicated) 1149 3235 10924.330570 $1222264.1700 $111.8800
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Total 3664 11269.208352 $1237143.0600 $109.7800
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Number of Children (Unduplicated) With at Least One Authorization 1164