Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 01-01-25 and 03-31-25 Date of Report: 04-06-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 10505 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 135 151 201.408732 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 135 151 201.408732 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 39 53 50.649315 $2456.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 9 9.571429 $590.6500 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 28 28 57.761111 $877.3900 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 5.000000 $107.3000 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 16.142857 $420.3600 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $32.3000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 5.000000 $121.4000 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 11 11 13.000000 $102.9600 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 4 17.000000 $540.7700 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 5.000000 $247.9500 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 5.000000 $75.9500 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 13 13 16.285714 $376.8500 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $54.9000 $54.9000
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 10.857143 $849.5700 $78.2500
EXIT -EXIT COS Exit 84 90 81.038454 $4051.9300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 13 26.000000 $1950.0000 $75.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 2.000000 $111.0000 $55.5000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $647.8400 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 11 21.500000 $1288.2800 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 4 4 7.500000 $607.3500 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 68 76 150.000000 $12147.0000 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 21 21 35.500000 $2874.7900 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 22 23 45.000000 $3644.1000 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 12 12 22.500000 $1822.0500 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 34 34 68.000000 $5506.6400 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 13 13 24.500000 $1984.0100 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 291 321 653.214286 $39140.6000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 97 100 192.000000 $11504.6400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 230 260 518.000000 $41947.6400 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 72 85 165.000000 $13361.7000 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 10 10 10.000000 $581.1000 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 3.587867 $208.4900 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 8 9 9.032877 $524.9000 $58.1100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.082192 $4.7800 $58.1200
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 11.000000 $639.2100 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 2.000000 $116.2200 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $58.1100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 5 31.580953 $1835.1700 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 6.428571 $373.5700 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 683 1263 2325.732769 $154868.9200 $66.5900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 33 46 52.275733 $261379.5000 $5000.0200
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.246575 $288.7400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 279 307 333.207275 $16660.3600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 52 60 51.282879 $2564.1400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 40 38.407861 $960.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 332 444 1023.541267 $51177.0400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 28 35 54.883330 $2744.1500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 7 8 10.088889 $252.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 117 152 321.588882 $16079.4100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 18 20 46.438094 $2321.9000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 9 12.683334 $317.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 125 160 370.547621 $18527.3900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 12 13 25.733334 $1286.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 3 5.033333 $125.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 183 235 505.012701 $25250.6400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 16 18 35.595236 $1779.7600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 10.488889 $262.2200 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 2.428571 $121.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1268 1715 13029.092942 $703570.3300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 195 246 1878.066675 $101415.4800 $54.0000
INTR -T1013 INTERPRETER 201 262 612.928574 $30646.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1492 2457 17314.105660 $207769.0600 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 38 50 311.890479 $25362.8900 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 6 6 29.676190 $2413.2600 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 2 2 7.971429 $648.2300 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.428571 $278.8100 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.428571 $34.8500 $81.3300
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 12.857143 $1045.5400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 80 106 684.642864 $55675.1200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 13 17 140.714287 $11442.8700 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 3 3 19.285715 $1568.3100 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 3 3 16.723810 $1359.9800 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.493151 $113.2400 $229.6300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 76 100 655.190483 $53280.0000 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 13 17 93.390477 $7594.5100 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 10 11 62.857143 $4093.2500 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 10.285714 $669.8000 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 7 7 67.933333 $5524.3400 $81.3200
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 2 3 5.476190 $356.6100 $65.1200
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 4.857143 $76.5500 $15.7600
TRAN -TRAN *FAMILY TRANSPORTATION 1 1 4.142857 $414.2900 $100.0000
TRAV -TRAVS Travel by mile 1515 2518 17281.524708 $7690.2700 $0.4400
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1634 9091 55149.447913 $1625212.0200 $29.4700
-------------------------------------------------------------------------------------------------------------------------------------
Total 10505 57676.589414 $1780080.9400 $30.8600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 1813