Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 06
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 4282 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 100 117 129.349201 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 100 117 129.349201 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 1 1 1.000000 $48.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 3 3.600000 $222.1600 $61.7100
AUDE -V5090 DISPENSING FEE PER HEARING AID 23 25 28.000000 $3242.6800 $115.8100
EXIT -EXIT COS Exit 189 192 192.000000 $9600.0000 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 8.857143 $530.7200 $59.9200
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Subtotal (Total Children Is Unduplicated) 213 222 233.457143 $13644.0500 $58.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 57 82 151.422227 $10501.1700 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.200000 $13.8700 $69.3500
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 146 152 123.513406 $6175.6700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 92 95 105.082637 $5254.1200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 16 18 14.016667 $350.4200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 20 28 49.754765 $2487.7500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 12 13 26.483336 $1324.1800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 2 2.450000 $61.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 9 10 14.521429 $726.0700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 10 10 26.733335 $1336.6800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 4.300000 $107.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 7 12.266667 $613.3400 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 5 7 8.816668 $440.8400 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3 3 7.866667 $393.3400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 4 4 4.766667 $238.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 1.500000 $37.5000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 5 6 161.714286 $4042.8600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1093 1479 11421.788778 $616777.3200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 90 112 813.238089 $43914.9100 $54.0000
INTR -T1013 INTERPRETER 85 138 865.330952 $43266.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1121 1564 12038.468137 $144461.7800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 10 11 81.704761 $6644.2400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 3 21.428571 $1395.4300 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 19 28 179.784125 $14620.0600 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 10.285714 $836.4300 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 3 18.352381 $1492.4200 $81.3200
PHY -97110HM PT SESSION BY PT ASST 7 11 69.114285 $4500.7200 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 4 6 42.571428 $2772.2500 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 23 28 31.000000 $7117.9100 $229.6100
SENS -V5264 EARMOLD 44 62 109.107939 $1978.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 40 284.209524 $23111.9300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 13 15 102.480950 $8333.7800 $81.3200
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Subtotal (Total Children Is Unduplicated) 1276 3943 26805.274391 $960328.7500 $35.8300
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Total 4282 27168.080735 $973972.8000 $35.8500
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Number of Children (Unduplicated) With at Least One Authorization 1359