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: 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 4212 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 10 14.890476 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 60.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 9 11 74.890476 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 90 108 86.297289 $4185.4300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 9 7.172603 $442.6200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 2 3 1.500000 $22.7900 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 6 6.000000 $145.6800 $24.2800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $23.1400 $23.1400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.000000 $78.2500 $78.2500
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.005479 $0.2500 $45.5000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 3.500000 $405.3400 $115.8100
EXIT -EXIT COS Exit 15 15 11.010960 $550.5400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 12.000000 $971.7600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 14.000000 $838.8800 $59.9200
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 94 95 147.609580 $11953.4600 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 27 27 53.000000 $4291.9400 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 51 54 105.000000 $8502.9000 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 21 22 44.000000 $3563.1200 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 140 142 237.109580 $14207.6300 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 40 40 79.000000 $4733.6800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 62 93 185.000000 $14981.3000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 8 9 18.500000 $1498.1300 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 5 1.191780 $69.2600 $58.1200
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.189041 $10.9800 $58.1000
OCTH -97165 OT EVAL LOW COMPLEXITY 92 114 84.357293 $4902.0100 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 6.033333 $350.6000 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 50 60 28.702736 $1667.9400 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 6 6 3.607686 $209.6400 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 1.000000 $58.1100 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 5 0.838356 $48.7200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 54 64 36.395889 $2114.9800 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 26 29 17.435920 $1013.2100 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 5 2.543836 $147.8200 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 95 117 84.787733 $4927.0200 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 4 4 2.066667 $120.1000 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.372222 $21.6300 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 23 28 16.650684 $967.5800 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 5 5 2.113698 $122.8300 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 3 2.246575 $130.5500 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 28 35 44.969864 $2613.2100 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.500000 $203.3900 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 0.700000 $40.6800 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 0.744444 $43.2600 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 18.714286 $1087.4800 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.122222 $7.1000 $58.1000
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Subtotal (Total Children Is Unduplicated) 504 1156 1393.989756 $93783.5500 $67.2800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 93 110 375.793924 $1878968.5000 $5000.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.153425 $10.6400 $69.3400
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 66 72 106.450210 $5322.5200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 23 25 24.358334 $1217.9200 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 433 574 1138.971437 $56948.6300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 7 21.557142 $1077.8600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 1 1 1.966667 $49.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 270 346 684.309527 $34215.4900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 3.133333 $156.6700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 2.066667 $51.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 4 6 9.500000 $475.0000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 1 2.300000 $115.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 6 10.133334 $253.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 386 484 938.609531 $46930.5100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 3 5.633333 $281.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 6 23.290476 $582.2600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 428 532 4163.666689 $224837.7200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 40 45 362.714285 $19586.5600 $54.0000
INTR -T1013 INTERPRETER 29 41 113.571429 $5678.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 36 73 309.176190 $3710.1100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 188 232 1945.476203 $158205.9200 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 4 4 28.142857 $2288.5800 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 2.700000 $219.5600 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 12.857143 $1045.5400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 90 106 1013.592864 $82425.2700 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 3 19.142857 $1556.7000 $81.3200
PHY -97110HM PT SESSION BY PT ASST 12 14 142.000001 $9247.0300 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 3 3 0.768493 $176.4600 $229.6100
SENS -V5264 EARMOLD 3 3 0.771233 $13.9800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 192 242 1945.394174 $158199.2600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 12 79.166668 $6437.8300 $81.3200
TRAV -TRAVS Travel by mile 46 88 9482.576193 $4219.7500 $0.4500
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Subtotal (Total Children Is Unduplicated) 634 3045 22969.944619 $2704505.6500 $117.7400
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Total 4212 24438.824851 $2798289.2000 $114.5000
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Number of Children (Unduplicated) With at Least One Authorization 746