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 2156 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 25 25.149207 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 25 25.149207 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 1.000000 $116.8300 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 144 183 155.307145 $7532.4000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 12 10.755556 $663.7300 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.066667 $1.0100 $15.2000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 8 11.766667 $285.7000 $24.2800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 3 2.272222 $72.2800 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $49.5900 $49.5900
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.655556 $51.3000 $78.2600
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 10 5.772222 $261.6000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.000000 $231.6200 $115.8100
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Subtotal (Total Children Is Unduplicated) 171 222 190.596035 $9266.0600 $48.6200
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 5 5 3.477778 $166.7300 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 50 56 79.261112 $396306.0000 $5000.0100
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 3 3 3.000000 $694.8600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 321 392 334.083729 $16704.1800 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 143 183 987.625394 $53331.7600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 12 15 84.642857 $4570.7100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 25 29 189.747621 $15430.2700 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 2 7.128571 $579.7000 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
OCCT -97530HM OT SESSION BY OT ASST 1 1 12.857143 $837.2500 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 6 6 34.006350 $2765.3900 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 2 2 15.857143 $1289.5000 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 1 2 8.071428 $525.6100 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 16 22 121.100001 $9847.8400 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 1.142857 $92.9400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 12.857143 $1045.5400 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 0.333333 $27.1000 $81.3100
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 12.857143 $1045.5400 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 5.000000 $2296.1000 $459.2200
SENS -V5264 EARMOLD 2 2 13.857143 $251.2300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 35 43 245.134922 $19934.3400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 25.000000 $2033.0000 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 2.500000 $203.3000 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 9.785714 $795.7800 $81.3200
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Subtotal (Total Children Is Unduplicated) 823 1909 3484.682135 $594462.4300 $170.5900
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Total 2156 3700.427377 $603728.4800 $163.1500
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Number of Children (Unduplicated) With at Least One Authorization 852