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 2350 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 11 12 7.027779 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 11 12 7.027779 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 60 60 60.000000 $1287.6000 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 58 58 58.000000 $936.7000 $16.1500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 58 58 58.000000 $459.3600 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 56 56 56.000000 $1781.3600 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 56 56 56.000000 $1295.8400 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
NUTR -97802 NUTRITIONAL EVAL, INITIAL 17 20 28.088888 $1404.4400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 20.857143 $1212.0100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 14 14 14.000000 $813.5400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 12.142857 $705.6200 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 4 26.166667 $1520.5500 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 8.714286 $506.3900 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 105 349 405.969841 $12375.4900 $30.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 307 426 666.601566 $33329.9800 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 77 91 135.939681 $6796.9800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 61 69 96.633327 $4831.6400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 215 265 363.866653 $18193.2700 $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 615 860 6537.681758 $353034.7800 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 58 67 558.420636 $45410.7600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 77 85 556.426193 $45248.5900 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5264 EARMOLD 2 2 2.000000 $36.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 108 120 960.385715 $78098.5700 $81.3200
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 948 1989 9890.669815 $595581.3400 $60.2200
-------------------------------------------------------------------------------------------------------------------------------------
Total 2350 10303.667435 $607956.8300 $59.0000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 964