Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 3917 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 42 47 44.992857 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 47 44.992857 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 1.455555 $89.8200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 15 16 13.983332 $212.4000 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 17 22 14.938891 $320.5900 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 3 9.362698 $243.8000 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 6.857143 $110.7400 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 3.600000 $87.4100 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 7.868254 $62.3200 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 3 4 14.811111 $471.1400 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 32 35 21.350001 $324.3100 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 7 4.322223 $100.0200 $23.1400
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $359.5200 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 10 13 13.000000 $755.4300 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 21 21 12.816669 $744.7900 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 3 0.733334 $42.6200 $58.1200
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.766667 $44.5500 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 12 13 8.533334 $495.8800 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 10 13 11.011111 $639.8600 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 2 2.000000 $116.2200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 19 23 11.211112 $651.4800 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.766667 $102.6600 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 3 2.505556 $145.6000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 37 43 28.305557 $1644.8400 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 1.122222 $65.2100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 20 22 18.988890 $1103.4500 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 8 5.488890 $318.9700 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 7 10 67.854763 $3943.0400 $58.1100
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Subtotal (Total Children Is Unduplicated) 181 284 294.653980 $13432.7300 $45.5900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 11.571429 $802.4800 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.288889 $20.0400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 5 6 10.000000 $2316.2000 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 196 275 244.721639 $12236.1500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 33 39 36.005556 $1800.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 22 24 30.638890 $765.9800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 736 1011 2934.145212 $146707.1400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 15 17 41.700002 $2085.0100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 12.733333 $318.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 349 473 1239.096802 $61954.7300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 14 18 30.666666 $1533.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.666667 $41.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 183 231 627.198397 $31359.8500 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 11 13 29.266665 $1463.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 6.533333 $163.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 395 509 1175.729343 $58786.3500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 10 13 24.799999 $1240.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.500000 $12.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 587 768 7219.511119 $389853.6000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 5 5 54.142857 $2923.7200 $54.0000
INTR -T1013 INTERPRETER 1 1 10.571429 $528.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 37 46 411.142856 $33434.1500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 22.285714 $1451.2400 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 29 41 381.009524 $30983.7000 $81.3200
PHY -97110HM PT SESSION BY PT ASST 1 2 26.000000 $1693.1200 $65.1200
SENS -V5264 EARMOLD 1 1 0.577778 $10.4800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 54 69 607.666666 $49415.4600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 12.000000 $975.8400 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 23.857142 $1553.5800 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 13.000000 $846.5600 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 24.285714 $1974.9100 $81.3200
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Subtotal (Total Children Is Unduplicated) 1135 3586 15264.313621 $844251.6000 $55.3100
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Total 3917 15603.960458 $857684.3300 $54.9700
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Number of Children (Unduplicated) With at Least One Authorization 1181