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: 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 3093 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 17 17 18.188889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 17 18.188889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 10 11 10.544444 $1231.9000 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 2 2 2.000000 $233.6600 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 87 103 83.938888 $4071.0300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 37 42 24.666665 $1522.1700 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 4 4 2.661111 $40.4200 $15.1900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 3 1.022222 $16.5100 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 47 51 43.799997 $1063.4600 $24.2800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.744444 $23.6800 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 5 2.533333 $125.6300 $49.5900
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 -1.011111 $-55.5100 $54.9000
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.488889 $38.2600 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 45 49 32.214284 $1459.9500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 6 2.800001 $324.2800 $115.8100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 10.428571 $606.0100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 10.553968 $613.2900 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 13.142857 $763.7300 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.944444 $54.8800 $58.1100
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Subtotal (Total Children Is Unduplicated) 221 289 241.473007 $12133.3400 $50.2500
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 14 15 16.755555 $803.2600 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.333333 $15.9800 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 57 66 122.509522 $612547.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.133333 $9.2400 $69.3300
AUDE -V5160 DISPENSING FEE BINAURAL 5 6 5.544444 $1284.1900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 225 258 232.000798 $11600.0500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 19 19 19.633333 $981.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 3 2.738889 $136.9500 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 6 6 0.661111 $33.0600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 6 7 -2.055556 $-102.7800 $50.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 3 14.587301 $393.8600 $27.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 757 1023 5918.844448 $319617.9400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 112 133 816.257938 $44078.0000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 167 202 509.965078 $41470.3700 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 12 13 63.563493 $5168.9900 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 12 13 31.982542 $2600.8200 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 16.857144 $1370.8200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 30 43 173.742856 $11314.1400 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 2 3 13.676190 $890.5900 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 99 122 399.429362 $32481.5900 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 25 29 102.657938 $8348.1300 $81.3200
OCCT -97530TLGOGT OT SESSION BY LICENSED OT 1 1 0.388889 $31.6300 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 0.165873 $13.4800 $81.2800
OCCT -97530TLGTHM OT SESSION BY OT ASST 2 2 18.142857 $1181.4700 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 15 23 50.638888 $3297.6200 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 150 167 584.346031 $47519.0300 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 7 8 34.026984 $2767.0800 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 7 8 63.709525 $5180.8600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 9 9 2.344444 $190.6500 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 84 100 276.869050 $22514.9900 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 2 3 13.428572 $1092.0100 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 7.541270 $613.2600 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 6 6.266667 $2877.7900 $459.2200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 2 2.000000 $1961.4800 $980.7400
SENS -V5264 EARMOLD 11 15 63.673017 $1154.3900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 249 309 776.341265 $63132.0500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 12 14 48.918255 $3978.0200 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 116 137 146.363487 $11902.2200 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 8 8 -9.401587 $-764.5300 $81.3200
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Subtotal (Total Children Is Unduplicated) 1201 2787 10548.582539 $1264215.9300 $119.8500
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Total 3093 10808.244435 $1276349.2700 $118.0900
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Number of Children (Unduplicated) With at Least One Authorization 1217