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 1278 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 24 28 24.322223 $1179.6300 $48.5000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 4 1.331507 $42.3600 $31.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.050000 $2.9100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 20 28 15.772224 $916.5300 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.361111 $20.9800 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 20 24 14.838892 $862.3100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 26 29 24.642065 $1431.9600 $58.1100
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Subtotal (Total Children Is Unduplicated) 77 115 81.318022 $4456.6700 $54.8100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 13 16 16.000000 $80000.0000 $5000.0000
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 295 421 2549.376195 $137666.3300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 28 40 184.933334 $15038.7800 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 23 27 174.071428 $14155.5100 $81.3200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.249315 $244.5000 $980.6800
SENS -V5264 EARMOLD 1 1 0.747945 $13.5600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 34 40 201.357144 $16374.3800 $81.3200
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Subtotal (Total Children Is Unduplicated) 545 984 3827.676722 $298585.3200 $78.0100
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Total 1278 4023.783633 $303041.9900 $75.3100
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Number of Children (Unduplicated) With at Least One Authorization 701