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 10845 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 152 174 222.757939 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 152 174 222.757939 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 67 88 86.526483 $4196.5400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 9.571429 $590.6500 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 6 8 20.571429 $312.4800 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $24.2800 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 3.500000 $27.7200 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $31.8100 $31.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $23.1400 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $54.9000 $54.9000
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 2 0.944444 $76.7200 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 5 5.000000 $226.6000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.500000 $173.7200 $115.8100
EXIT -EXIT COS Exit 111 124 108.080692 $5404.0300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 5 10.000000 $750.0000 $75.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 2.000000 $111.0000 $55.5000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 3 6.000000 $359.5200 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 11 22.000000 $1781.5600 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 9 9 13.000000 $1052.7400 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 7 7 14.000000 $1133.7200 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 8.000000 $647.8400 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 5 5 7.500000 $607.3500 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 29 31 62.000000 $3715.0400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 13 14 23.500000 $1408.1200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 22 25 50.000000 $4049.0000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 5 8 15.000000 $1214.7000 $80.9800
OCTH -97165 OT EVAL LOW 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 3 3 3.000000 $174.3300 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.922222 $13.9300 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 18.428572 $1070.8800 $58.1100
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Subtotal (Total Children Is Unduplicated) 268 382 504.045271 $29755.3100 $59.0300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 32 44 43.845052 $219225.5000 $5000.0100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.383333 $95.9300 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 420 470 528.174041 $26408.6900 $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 488 647 1491.187295 $74559.3200 $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 187 239 528.306341 $26415.2700 $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 206 260 593.448408 $29672.3900 $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 298 375 836.600793 $41830.0200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 33 37 74.230158 $3711.5100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 14 27.600000 $690.0000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 4 28.142857 $1407.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 173 211 1543.542866 $83351.2300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 39 50 341.466666 $18439.1900 $54.0000
INTR -T1013 INTERPRETER 208 269 601.928574 $30096.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2112 3567 24611.319980 $295335.5400 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 14 81.666668 $6641.1300 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 1.733333 $140.9500 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 34 43 317.857146 $25848.1200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 5 6 43.028572 $3499.0900 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 12.857143 $1045.5400 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.500000 $344.4200 $229.6100
SENS -V5264 EARMOLD 4 6 8.266667 $149.8800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 36 46 280.166670 $22783.1400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 6 58.028572 $4718.8900 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 25.142857 $1637.3000 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 2 12.857143 $837.2600 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 34.285714 $2788.1100 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 12.000000 $189.1200 $15.7600
TRAN -TRAN *FAMILY TRANSPORTATION 1 1 4.142857 $414.2900 $100.0000
TRAV -TRAVS Travel by mile 2149 3661 24589.253315 $10942.2100 $0.4400
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Subtotal (Total Children Is Unduplicated) 2277 10289 57143.126769 $951320.7400 $16.6500
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Total 10845 57869.929979 $981076.0500 $16.9500
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Number of Children (Unduplicated) With at Least One Authorization 2388