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 893 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 5 6 5.544444 $647.7500 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 79 93 71.938888 $3489.0300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 5 2.722222 $167.9900 $61.7100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 9 11.533333 $280.0300 $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 10 10 13.284920 $602.0800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.755556 $87.5100 $115.8200
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 10.428571 $606.0100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 5.580953 $324.3100 $58.1100
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Subtotal (Total Children Is Unduplicated) 108 138 124.544442 $6336.7500 $50.8800
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 4 4 4.044444 $193.8900 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 34 39 90.098412 $450492.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 224 257 231.500798 $11575.0500 $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
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 134 166 985.963488 $53242.0900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 27 32 202.055558 $10911.0100 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 48 60 160.927783 $13086.6800 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 2 13.409524 $1090.4700 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 2 2 13.142858 $1068.7700 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.714286 $302.0500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 2 2 3.338096 $217.3800 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 10 13 31.461905 $2558.4700 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 2 2 -5.571429 $-453.0700 $81.3200
OCCT -97530TLGOGT OT SESSION BY LICENSED OT 1 1 0.388889 $31.6300 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
PHY -97110 PT SESSION BY LICENSED PT 26 29 140.132540 $11395.5700 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 2 2 5.100000 $414.7300 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 2 2 -25.766667 $-2095.3500 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 6 8 27.577778 $2242.6300 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 0.755556 $346.9900 $459.2500
SENS -V5264 EARMOLD 4 6 30.326985 $549.8300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 50 58 119.064286 $9682.3000 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 11 11 3.304761 $268.7300 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 -26.000000 $-2114.3200 $81.3200
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Subtotal (Total Children Is Unduplicated) 440 738 2033.019057 $566753.0500 $278.7700
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Total 893 2175.752388 $573089.8100 $263.4000
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Number of Children (Unduplicated) With at Least One Authorization 496