Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 54
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 3598 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 26 26 23.411110 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 26 26 23.411110 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 10 10 8.177778 $955.4100 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 6 6 5.316667 $621.1500 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 118 138 112.448419 $5453.7800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 37 41 25.527780 $1575.3300 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 1.505556 $22.8700 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $21.4600 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $26.0400 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 3.061111 $49.4400 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 64 73 59.377784 $1441.7100 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 2.000000 $15.8400 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 5 3.083333 $98.0800 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 4.011111 $198.9100 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.000000 $30.3800 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 3 3 3.011111 $69.6800 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 47 54 24.555564 $1112.9000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 7 4.266668 $494.1400 $115.8100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 7.827778 $454.8700 $58.1100
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Subtotal (Total Children Is Unduplicated) 264 357 268.170660 $12641.9900 $47.1400
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 15 16 11.833335 $567.3000 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 6 7 5.377778 $257.8100 $47.9400
AACFIT-92609TLGT AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.633333 $30.3600 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 61 72 110.966664 $554832.0000 $4999.9900
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 2.000000 $138.7000 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.285714 $227.8600 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 7 8 7.011111 $1623.9100 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 294 370 329.846039 $16492.3400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 25 28 25.166667 $1258.3400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 0.250000 $6.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 79 92 92.302380 $4615.1300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 0.272222 $13.6100 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 176 177 187.949206 $9397.4600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 1.677777 $41.9400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 125 127 145.889683 $7294.4900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 246 263 250.957144 $12547.8600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 10 10 6.388888 $159.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 8 45.485714 $1228.1200 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 792 1047 6208.570632 $335262.7600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 70 82 485.788889 $26232.6000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 135 159 711.988888 $57898.9200 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 8 10 54.857144 $4460.9800 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 6.500000 $528.5800 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 22.357143 $1818.0800 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 25 34 162.649205 $10591.7100 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 10.857143 $707.0100 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 78 87 415.938891 $33824.1600 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 26 31 171.546030 $13950.1500 $81.3200
OCCT -97530TLGOGT OT SESSION BY LICENSED OT 1 1 1.011111 $82.2200 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 2.344444 $190.6500 $81.3200
OCCT -97530TLHM OT SESSION BY OT ASST 14 19 76.452382 $4978.5800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 92 110 477.557934 $38835.0300 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 2 2 0.975397 $79.3200 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 6 7 27.357142 $2224.6900 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 6 7 41.690475 $3390.2700 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 55 63 296.219844 $24088.5900 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 2.857143 $232.3400 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 3 4 14.710317 $1196.2400 $81.3200
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 9 11.905556 $5467.2900 $459.2200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 2 2 2.000000 $1961.4800 $980.7400
SENS -V5264 EARMOLD 8 12 36.888888 $668.7900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 179 215 804.752379 $65442.4700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 20 21 92.964287 $7559.8600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 80 92 211.953969 $17236.0800 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 6 6 31.080952 $2527.5100 $81.3200
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Subtotal (Total Children Is Unduplicated) 1247 3215 11611.069840 $1272169.5400 $109.5700
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Total 3598 11902.651610 $1284811.5300 $107.9400
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Number of Children (Unduplicated) With at Least One Authorization 1268