Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 3779 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 40 45 39.005554 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 40 45 39.005554 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 38 40 25.016667 $1543.7800 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 30 30 23.166666 $351.9000 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 32 34 27.396031 $587.9200 $21.4600
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 11 6.255555 $151.8800 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.427778 $11.3100 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 22 24 19.871615 $632.1200 $31.8100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 47 53 33.972220 $516.0300 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 37 41 31.983334 $740.1000 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.533333 $24.1700 $45.3200
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.011111 $0.6700 $59.8600
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.011111 $0.9000 $80.9000
OCTF -97168 OT RE-EVAL EST PLAN CARE 13 15 14.066667 $817.4200 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 48 55 35.327776 $2052.8900 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 5 1.033333 $60.0500 $58.1100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 8 5.000000 $290.5500 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 2.188889 $127.2000 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 18 22 16.466667 $956.8800 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.500000 $29.0600 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.238889 $13.8800 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 16 15.294444 $888.7600 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 22 30 16.100001 $935.5800 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.294444 $17.1100 $58.1000
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 17 10.644444 $618.5500 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.488889 $28.4100 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 0.277778 $16.1400 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 78 95 63.816671 $3708.4100 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 1.900000 $110.4100 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.261111 $15.1700 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 13 15 14.077777 $818.0600 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 4.000000 $232.4400 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.355556 $20.6600 $58.1200
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.144444 $8.3900 $58.0900
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 45 52 34.544444 $2007.3800 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.916667 $111.3800 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 15 16 16.050000 $932.6700 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 3.000000 $174.3300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 16 20 189.428572 $11007.7000 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 7.714286 $448.2800 $58.1100
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Subtotal (Total Children Is Unduplicated) 423 633 629.777170 $31299.0400 $49.7000
EI Services, Class # 03
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.200000 $13.8700 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 12.533333 $2902.9600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 127 165 156.143260 $7807.1900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 9 9 9.000000 $450.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 17 20 20.166667 $504.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 409 565 1730.957943 $86547.9300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 9 11 21.933333 $1096.6700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 200 267 659.866669 $32993.3400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 8 10 17.166667 $858.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 4.100000 $102.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 83 116 308.133333 $15406.6700 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.700000 $135.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 1 1 2.066667 $51.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 222 281 614.728569 $30736.4200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 5 6 13.633333 $681.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 2.066667 $51.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 939 1201 11084.123882 $598542.1500 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 73 92 753.547618 $40691.5500 $54.0000
INTR -T1013 INTERPRETER 1 1 8.428571 $421.4300 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 62 83 830.857148 $67565.2400 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 3 3 20.000000 $1626.4000 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 25.142857 $2044.6200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 14 17 138.914287 $9046.1000 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 2 12.857143 $837.2500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 44 64 569.661911 $46324.8400 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 7.571429 $615.7100 $81.3200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.533333 $523.0300 $980.6800
SENS -V5264 EARMOLD 1 1 0.200000 $3.6300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 115 148 1240.576198 $100883.5700 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 9 12 99.142857 $6456.1900 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 3 27.714285 $1804.7600 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 14.571429 $1184.9500 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 7.714286 $627.3300 $81.3200
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 2 2 23.428572 $1525.6600 $65.1200
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Subtotal (Total Children Is Unduplicated) 1045 3101 18440.382247 $1061064.4300 $57.5400
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Total 3779 19109.164971 $1092363.4800 $57.1600
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Number of Children (Unduplicated) With at Least One Authorization 1080