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
Eligibility Filter: Program Patients
With the filters selected there were 15591 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 188 210 195.619838 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 188 210 195.619838 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 75 87 87.558449 $4246.5800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 30 32 71.100000 $4387.5800 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 43 46 82.615872 $1254.9400 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 6 6.333333 $135.9100 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 7 7.333333 $190.9600 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 4 3.400000 $54.9100 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 10 11 13.390476 $325.1200 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 16 17 17.066666 $135.1700 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 7 16.761904 $533.2000 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 5 5.333333 $264.4800 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 6 6.333333 $96.2000 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 22 24 34.761904 $804.3900 $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
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 4 2.466667 $200.3900 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 7 6.249315 $283.2200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 4 2.444445 $283.1000 $115.8100
EXIT -EXIT COS Exit 138 150 127.083759 $6354.1800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 12 21 41.000000 $3075.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 18.000000 $1457.6400 $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 31 33 64.000000 $3834.8800 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 10.000000 $599.2000 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 25 29 57.000000 $4615.8600 $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 80 95 188.000000 $15224.2400 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 27 30 56.500000 $4575.3700 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 21 22 44.000000 $3563.1200 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 10 11 20.500000 $1660.0900 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 55 55 109.500000 $8867.3100 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 25 26 46.000000 $3725.0800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 424 466 918.796672 $55054.3000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 149 157 301.000000 $18035.9200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 381 458 903.296672 $73148.9700 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 112 138 273.000000 $22107.5400 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 7.000000 $406.7700 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 14.000000 $813.5400 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 9 9 8.054795 $468.0600 $58.1100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.260426 $19.0400 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 22 22 23.571429 $1369.7300 $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 3 3 2.249315 $130.7100 $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 3 3 2.106849 $122.4300 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 12 12 73.376192 $4263.9000 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 3 3 11.638095 $676.3000 $58.1100
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Subtotal (Total Children Is Unduplicated) 1098 2051 3720.816567 $250069.9100 $67.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 64 74 79.350684 $396753.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 3 10.000000 $693.5000 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 3 2.022222 $140.2400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 10 12 13.194521 $3056.1100 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 348 395 415.168886 $20758.4500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 89 101 87.717355 $4385.8500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 51 53 78.704109 $1967.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 499 624 1432.213463 $71610.5200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 69 87 169.448405 $8472.3800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 15 16 39.333332 $983.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 173 205 425.963479 $21298.1100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 30 33 64.614282 $3230.7000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 11 12 20.866665 $521.6600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 215 265 623.022212 $31151.0600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 29 35 133.680013 $6683.9900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 10 10 42.599999 $1065.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 295 351 878.604740 $43930.1200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 35 42 94.895887 $4744.7800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 12 13 30.533331 $763.3300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 6 32.714287 $1635.7100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1892 2402 19196.717504 $1036622.7700 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 270 356 2494.571433 $134706.8900 $54.0000
INTR -T1013 INTERPRETER 270 340 713.952382 $35697.6200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2277 3615 26212.608339 $314551.3000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 69 88 585.928574 $47647.7200 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 8 8 52.266668 $4250.3400 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 2 4.566667 $371.3600 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 4 4 35.285714 $2869.4400 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 13.428571 $1092.0100 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 150 194 1575.182544 $128093.8800 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 1 78.000000 $6342.9600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 15 19 197.857143 $16089.7400 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 5 5 49.361905 $4014.1000 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 3.961904 $322.1800 $81.3200
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5060 BEHIND EAR HEARING AID 4 6 5.833486 $1339.4300 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 5.000000 $2296.1000 $459.2200
SENS -V5264 EARMOLD 8 12 11.754947 $213.1200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 173 201 1497.595249 $121784.4400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 19 19 145.457142 $11828.5700 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 10 10 69.733333 $4541.0300 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 2 13.142857 $855.8700 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 10 11 140.390477 $11416.5600 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 7.000000 $569.2400 $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 7 7 65.428572 $1031.1500 $15.7600
TRAV -TRAVS Travel by mile 2302 3677 26274.946438 $11692.3500 $0.4500
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Subtotal (Total Children Is Unduplicated) 2472 13330 84139.619721 $2525112.5900 $30.0100
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Total 15591 88056.056126 $2775182.5000 $31.5200
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Number of Children (Unduplicated) With at Least One Authorization 2765