Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 04-01-25 and 06-30-25 Date of Report: 07-19-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2511 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 159 179 114.788889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 159 179 114.788889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 35 41 35.622223 $1727.6800 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.194444 $2.9500 $15.1900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 16 17 12.114840 $385.3700 $31.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 0.380822 $44.1100 $115.8300
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.555556 $32.2900 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 83 99 61.811122 $3591.9100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 1.911111 $111.0500 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 95 114 63.622238 $3697.1800 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.355556 $20.6600 $58.1200
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.077778 $4.5200 $58.1300
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 122 153 119.794450 $6961.2900 $58.1100
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Subtotal (Total Children Is Unduplicated) 295 436 297.440140 $16637.1300 $55.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 34 41 37.129910 $185650.0000 $5000.0100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.249315 $57.7400 $231.6100
CONIF -CONIF CONSULT, ITDS FACE TO FACE 21 24 45.799997 $2289.9900 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 146 175 288.715864 $14435.7500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 61 82 116.931744 $5846.5800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 120 156 249.244441 $12462.2100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 681 992 5732.685726 $309565.0500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2 2 12.571428 $678.8600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 87 119 687.100005 $55875.0200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 93 126 802.512698 $65260.3500 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.380822 $87.4600 $229.6600
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.249315 $244.5000 $980.6800
SENS -V5264 EARMOLD 3 3 1.128767 $20.4700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 125 172 973.957147 $79202.2400 $81.3200
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Subtotal (Total Children Is Unduplicated) 951 1896 8948.657179 $731676.2000 $81.7600
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Total 2511 9360.886208 $748313.3300 $79.9400
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Number of Children (Unduplicated) With at Least One Authorization 1096