Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 4420 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 108 122 158.278563 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 108 122 158.278563 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 3.033333 $187.1800 $61.7100
AUDE -V5090 DISPENSING FEE PER HEARING AID 21 23 27.000000 $3126.8700 $115.8100
EXIT -EXIT COS Exit 153 153 152.142857 $7607.1500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
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Subtotal (Total Children Is Unduplicated) 175 180 186.176190 $11191.0400 $60.1100
EI Services, Class # 03
AUD -92630 AUD REHAB PRELING HEARING LOSS 58 79 143.565076 $9956.2100 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 3.088889 $214.2200 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 124 127 105.803499 $5290.1900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 75 77 68.749633 $3437.4900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 33 34 34.065402 $851.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 16 18 32.249998 $1612.4900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 8 10 14.266666 $713.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 6 17.338095 $433.4500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 7 8 14.016666 $700.8300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 7 8 13.933333 $696.6700 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 3 6 6.266667 $313.3400 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.950000 $147.5000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 3.033333 $75.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4 4 8.050000 $402.5000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 4 5.633333 $281.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 9.700000 $242.5000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 21 24 628.571426 $15714.3000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 4.571429 $123.4300 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1112 1492 11597.476210 $626263.7700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 86 105 748.285719 $40407.4300 $54.0000
INTR -T1013 INTERPRETER 119 186 867.240475 $43362.0300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1161 1622 12487.589702 $149851.0900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 14 20 114.890476 $9342.8900 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 36.142857 $2939.1400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 4 6 45.000000 $2930.4000 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 3.642857 $237.2300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 36 54 328.774203 $26735.9000 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 2 2 9.104762 $740.3900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 6 6 39.569842 $3217.8200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 13 22 111.438097 $7256.8500 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 9 14 86.428572 $5628.2200 $65.1200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 2.000000 $229.6200 $114.8100
SENS -V5060 BEHIND EAR HEARING AID 19 21 23.000000 $5281.0300 $229.6100
SENS -V5264 EARMOLD 41 54 88.771428 $1609.4200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 54 71 495.359523 $40282.6300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 17 23 160.571428 $13057.6600 $81.3200
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Subtotal (Total Children Is Unduplicated) 1346 4118 28361.139596 $1020581.0700 $35.9900
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Total 4420 28705.594349 $1031772.1100 $35.9400
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Number of Children (Unduplicated) With at Least One Authorization 1420