Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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: 07-01-24 and 09-30-24 Date of Report: 04-06-25 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 4436 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 8 8 10.603174 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 61.333333 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 9 71.936507 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 77 93 68.367286 $3315.8300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 7 7.318721 $451.6400 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 2 1.061111 $16.1200 $15.1900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.283333 $4.5800 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.000000 $48.5600 $24.2800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.634399 $28.7500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.511111 $59.1900 $115.8100
EXIT -EXIT COS Exit 15 15 14.002740 $700.1400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 3 4.005479 $324.3700 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3300 $60.1600
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 81 81 140.054790 $11341.6500 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 19 19 36.005556 $2915.7300 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 46 47 88.500000 $7166.7300 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 21 22 44.000000 $3563.1200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 92 93 161.054790 $9650.4200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 27 27 54.000000 $3235.6800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 62 85 165.500000 $13402.1900 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 12 21 42.000000 $3401.1600 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 6 6 1.060807 $61.6400 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 3 3 0.235617 $13.6900 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 86 96 78.385246 $4554.9800 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 4 5 4.822223 $280.2200 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 32 39 18.064917 $1049.7700 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 5 5 1.758904 $102.2200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 2 0.511112 $29.7100 $58.1200
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 5 3.194368 $185.6200 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 0.257534 $14.9700 $58.1200
PSTH -97161 PT EVAL LOW COMPLEXITY 57 69 49.795596 $2893.6400 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 4 5 5.888889 $342.2000 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 16 19 9.896501 $575.1000 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 3 1.331507 $77.3800 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 110 127 98.112274 $5701.3300 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 3 2.252055 $130.8700 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 16 23 11.241444 $653.2400 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 6 6 0.892999 $51.8900 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 -0.005479 $-0.3200 $58.3300
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.093151 $5.4200 $58.1400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 29 35 37.435899 $2175.4000 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 1.244444 $72.3100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 4 0.918722 $53.3900 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 4.000000 $232.4400 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 11.142857 $647.5100 $58.1100
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Subtotal (Total Children Is Unduplicated) 423 995 1190.836382 $80920.7200 $67.9500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 79 96 261.052957 $1305266.5000 $5000.0100
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.533333 $586.7600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 83 87 107.475691 $5373.7800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 16 16 20.316667 $1015.8400 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 441 605 1292.314312 $64615.8500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 9 11 20.233334 $1011.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.100000 $27.5000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 256 314 660.099694 $33005.0900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 3 3 6.200000 $310.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 3 6.133333 $153.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 8 10 16.633333 $831.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 6 12.266667 $306.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 398 499 1059.376213 $52968.9200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 2 2.900000 $145.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 10 19.442857 $486.0700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 409 525 4214.300005 $227572.4500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 61 65 606.571429 $32754.9000 $54.0000
INTR -T1013 INTERPRETER 26 38 114.271915 $5713.6100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 124 271 1144.895237 $13738.7600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 160 194 1597.607941 $129917.5500 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 0.266667 $21.6900 $81.3300
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 5.000000 $406.6000 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 85 102 982.841268 $79924.7500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 11 13 131.999999 $8595.8500 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.511111 $117.3500 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.533333 $704.1200 $459.2100
SENS -V5264 EARMOLD 1 1 0.511111 $9.2700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 196 237 1937.085888 $157524.0300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 5 23.000000 $1870.3600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 -0.285714 $-23.2300 $81.3200
TRAV -TRAVS Travel by mile 125 311 61895.621539 $27543.5500 $0.4500
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Subtotal (Total Children Is Unduplicated) 605 3432 76143.810120 $2152496.2500 $28.2700
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Total 4436 77406.583009 $2233416.9700 $28.8500
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Number of Children (Unduplicated) With at Least One Authorization 666