Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 03
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: 10-01-25 and 12-31-25 Date of Report: 01-07-26 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 2328 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 173 197 157.911109 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 173 197 157.911109 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 40 47 45.526190 $2208.0200 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.322222 $4.8900 $15.1900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 9 9 7.589193 $241.4100 $31.8100
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 0.455556 $26.4700 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 86 117 73.999998 $4300.1300 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 67 87 45.683329 $2654.6300 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 136 169 117.125391 $6806.1300 $58.1100
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Subtotal (Total Children Is Unduplicated) 271 432 290.701879 $16241.7000 $55.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 39 44 41.649924 $208249.0000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.252055 $58.3900 $231.6600
CONIF -CONIF CONSULT, ITDS FACE TO FACE 18 22 34.011112 $1700.5600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 129 155 286.677775 $14333.8800 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 71 98 148.933335 $7446.6800 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 110 122 217.866675 $10893.3800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 681 878 5942.098334 $320873.8000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 13.142857 $709.7200 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 87 122 729.161901 $59295.4900 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 64 87 541.814278 $44060.3900 $81.3200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.252055 $247.2400 $980.9200
SENS -V5264 EARMOLD 1 1 0.252055 $4.5700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 136 167 1107.525382 $90064.1100 $81.3200
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Subtotal (Total Children Is Unduplicated) 930 1699 9063.637738 $757937.1900 $83.6200
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Total 2328 9512.250726 $774178.8900 $81.3900
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Number of Children (Unduplicated) With at Least One Authorization 1095