Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 10
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 11667 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 13 14 8.327779 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 13 14 8.327779 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 2.000000 $30.3800 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1188 1231 1245.143247 $26720.7700 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1176 1216 1230.143247 $19866.8100 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1176 1216 1230.143247 $9742.7300 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.8800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1173 1213 1227.143247 $39035.4300 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 3.000000 $45.5700 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1165 1205 1219.143247 $28210.9700 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $54.9000 $54.9000
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 1.000000 $81.2400 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.000000 $90.6400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 3.000000 $347.4300 $115.8100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 18 21 30.422221 $1521.1100 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 69 74 85.768254 $4983.9900 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 11 11 11.000000 $639.2100 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 17 21 22.000000 $1278.4200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 5.000000 $290.5500 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 106 112 112.179365 $6518.7400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 21 23 26.853968 $1560.4900 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 33 39 389.342857 $22624.7200 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 5 6 43.000001 $2498.7300 $58.1100
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Subtotal (Total Children Is Unduplicated) 1336 6410 6895.282901 $166444.2500 $24.1400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 24 24.000000 $120000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 308 428 669.034899 $33451.6500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 78 92 138.039681 $6901.9800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 61 69 96.633327 $4831.6400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 216 266 366.899986 $18344.9300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 9.714286 $485.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1716 2457 19525.442082 $1054373.8800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 7.571429 $408.8600 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 366 486 3714.681352 $302077.8600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 510 678 4140.909537 $336738.7100 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 3.000000 $688.8300 $229.6100
SENS -V5264 EARMOLD 4 4 5.000000 $90.6500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 554 730 5000.961917 $406678.1800 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 4 4 13.857143 $1126.8700 $81.3200
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Subtotal (Total Children Is Unduplicated) 2294 5243 33716.745639 $2286314.5500 $67.8100
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Total 11667 40620.356319 $2452758.8100 $60.3800
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Number of Children (Unduplicated) With at Least One Authorization 2326