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: 04-01-25 and 06-30-25 Date of Report: 07-19-25 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 10836 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 141 161 157.211110 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 141 161 157.211110 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 35 44 38.246577 $1854.9600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 11 23.000000 $1419.3300 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 30 32 63.404761 $963.1200 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 5 5.933333 $127.3300 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 5 5.933333 $154.5000 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 3 3.000000 $48.4500 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 7 9.990476 $242.5700 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 11 12 12.933333 $102.4300 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 4 6 16.361904 $520.4700 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 4 4.933333 $244.6400 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 5 5.933333 $90.1300 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 13 15 15.933333 $368.7000 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 2 2 3.733333 $204.9600 $54.9000
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 13.000000 $1017.2500 $78.2500
EXIT -EXIT COS Exit 95 101 87.255480 $4362.7700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 14 28.000000 $2100.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 12.000000 $971.7600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 6.000000 $485.8800 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 21 22 44.000000 $2636.4800 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 8.000000 $479.3600 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 18 22 44.000000 $3563.1200 $80.9800
IPDEF -T1024TSTLGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 54 66 131.000000 $10608.3800 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 14 16 30.000000 $2429.4000 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 12 13 26.000000 $2105.4800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 7 8 15.000000 $1214.7000 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 42 42 84.000000 $6802.3200 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 14 15 27.500000 $2226.9500 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 286 317 629.791193 $37737.0900 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 116 123 238.000000 $14260.9600 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 264 318 630.291193 $51040.9800 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 86 101 200.000000 $16196.0000 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 6 6 6.000000 $348.6600 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 13.000000 $755.4300 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 5.054795 $293.7300 $58.1100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 17 17 18.571429 $1079.1800 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 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
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 6 6 32.333334 $1878.9000 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 6.209524 $360.8400 $58.1100
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Subtotal (Total Children Is Unduplicated) 743 1392 2559.343997 $172351.8200 $67.3400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 28 35 32.466209 $162330.5000 $4999.9800
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 9.000000 $624.1500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 2.194521 $508.2900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 240 263 270.048763 $13502.4500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 63 71 64.196807 $3209.8300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 37 38 49.769407 $1244.2400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 349 427 1006.899977 $50344.8700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 45 58 113.081743 $5654.0700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 14 15 37.833332 $945.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 110 130 249.444437 $12472.1900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 23 26 53.480950 $2674.0400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 6 6 11.299999 $282.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 139 165 400.099991 $20004.9600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 18 22 43.783332 $2189.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 7 36.533333 $913.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 187 216 507.754745 $25387.6500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 20 23 58.233332 $2911.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 8 8 21.166665 $529.1600 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 2 10.142858 $507.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1408 1784 14510.571468 $783570.8400 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 187 253 1724.361905 $93115.5600 $54.0000
INTR -T1013 INTERPRETER 237 298 654.119049 $32705.9600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1637 2547 18772.862734 $225274.3400 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 37 47 319.495240 $25981.3600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 7 7 46.200001 $3756.9900 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 8.142857 $662.1800 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.428571 $34.8500 $81.3300
PHY -97110 PT SESSION BY LICENSED PT 81 103 806.149209 $65556.0800 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 1 78.000000 $6342.9600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 9 13 137.000000 $11140.8400 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 4 4 37.790476 $3073.1200 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 3.961904 $322.1800 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.389041 $89.3200 $229.5900
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 76 88 640.119055 $52054.4900 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 9 74.328571 $6044.4000 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 7 56.033333 $3648.8900 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 0.142857 $9.3100 $65.1400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 6 7 106.466667 $8657.8700 $81.3200
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 2 2 14.000000 $911.6800 $65.1200
SPL -92508HA GROUP SPL SESSION PER CHILD 3 3 38.000000 $598.8800 $15.7600
TRAV -TRAVS Travel by mile 1654 2586 18817.272260 $8373.6900 $0.4500
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Subtotal (Total Children Is Unduplicated) 1775 9283 59824.265599 $1638179.9000 $27.3800
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Total 10836 62540.820706 $1810531.7300 $28.9500
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Number of Children (Unduplicated) With at Least One Authorization 1973