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
Eligibility Filter: Program Patients
With the filters selected there were 15509 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 176 201 238.491272 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 176 201 238.491272 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 80 107 106.184931 $5149.9800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 24 27 39.071429 $2411.1000 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 43 49 100.761111 $1530.5600 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 5 8.000000 $171.6800 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 6 19.142857 $498.4800 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 5 5.200000 $83.9800 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 7 10.000000 $242.8000 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 15 16 18.700000 $148.1000 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 8 21.400000 $680.7300 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 5 8.000000 $396.7200 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 6 8.200000 $124.5600 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 20 22 39.142857 $905.7600 $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
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 2 0.944444 $76.7200 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 8 7.191781 $325.9300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 3.500000 $405.3400 $115.8100
EXIT -EXIT COS Exit 126 140 121.723549 $6086.1800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 16 27 54.000000 $4050.0000 $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 -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $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 18 20 39.500000 $2366.8400 $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 5 6 11.500000 $931.2700 $80.9800
IPDEF -T1024TSTLGT F/U PHYC AND DEV EVAL BY EI PROF 1 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 90 101 198.500000 $16074.5300 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 31 31 50.000000 $4049.0000 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 31 32 63.000000 $5101.7400 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 17 17 31.000000 $2510.3800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 43 43 86.000000 $6964.2800 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 19 19 34.000000 $2753.3200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 420 462 932.000000 $55845.4400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 134 138 261.500000 $15669.0800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 352 399 793.285714 $64240.2800 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 103 126 246.000000 $19921.0800 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 13 13 13.000000 $755.4300 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 4.722114 $274.4000 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 3.000000 $174.3300 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 11 12 12.032877 $699.2300 $58.1100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.082192 $62.8900 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 1.344140 $20.3100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 16 16 16.000000 $929.7600 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 4 4 4.000000 $232.4400 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $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 2 2 1.246575 $72.4400 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.120548 $7.0000 $58.0900
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 9 11 90.628572 $5266.4200 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 6.428571 $373.5700 $58.1100
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Subtotal (Total Children Is Unduplicated) 1032 1938 3518.911405 $231990.5500 $65.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 71 99 104.059597 $520299.0000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 4 4.200000 $291.2700 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.727777 $119.8200 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 9 11 12.246575 $2836.5600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 423 473 531.674041 $26583.6900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 81 92 78.297949 $3914.8900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 63 64 63.257861 $1581.4500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 488 649 1493.487295 $74674.3200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 50 63 111.084919 $5554.2400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 9 10 11.922223 $298.0600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 187 240 530.906341 $26545.2700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 26 28 61.604761 $3080.2300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 11 15 21.550001 $538.7500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 208 262 601.881742 $30094.0600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 23 26 47.446034 $2372.3100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 5 6 12.000000 $300.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 301 378 840.600793 $42030.0200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 34 38 77.230158 $3861.5100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 14 27.600000 $690.0000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 5 34.714286 $1735.7100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1745 2353 17633.860433 $952227.5100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 278 354 2696.038105 $145585.9000 $54.0000
INTR -T1013 INTERPRETER 229 293 666.928574 $33346.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2112 3570 24621.748552 $295460.6800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 90 590.947625 $48055.7900 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 7 7 31.409523 $2554.2100 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 3 3 13.971429 $1136.1500 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 3.428571 $278.8100 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 4 6 28.142856 $2288.5900 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 12.857143 $1045.5400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 148 198 1384.676201 $112601.7700 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 20 26 189.885715 $15441.4900 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 3 3 19.285715 $1568.3100 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 22.866667 $1859.5200 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 2 2.000000 $229.6200 $114.8100
SENS -V5060 BEHIND EAR HEARING AID 4 5 5.993151 $1376.1000 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 4 6.000000 $2755.3200 $459.2200
SENS -V5264 EARMOLD 9 15 13.930289 $252.5600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 172 227 1547.247630 $125822.0400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 23 29 203.457145 $16545.1400 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 13 14 81.571429 $5311.9200 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 3 23.142857 $1507.0700 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 10 10 86.104762 $7002.0300 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 12.857143 $1045.5400 $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 6 6 51.571429 $812.7700 $15.7600
TRAN -TRAN *FAMILY TRANSPORTATION 1 1 4.142857 $414.2900 $100.0000
TRAV -TRAVS Travel by mile 2149 3662 24596.253315 $10945.3200 $0.4400
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Subtotal (Total Children Is Unduplicated) 2309 13370 79223.287659 $2535228.1500 $32.0000
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Total 15509 82980.690336 $2767218.7000 $33.3500
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Number of Children (Unduplicated) With at Least One Authorization 2573