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 10799 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 162 182 178.769839 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 162 182 178.769839 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 62 73 72.842467 $3532.8600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 9 21.000000 $1295.9100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 5 7.000000 $106.3300 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 3.000000 $72.8400 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 2.733333 $21.6500 $7.9200
AUDE -92650 AEP SCR AUDITORY POTENTIAL 2 2 3.733333 $204.9600 $54.9000
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 4 2.466667 $200.3900 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 5 5.000000 $226.6000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 1.444445 $167.2900 $115.8100
EXIT -EXIT COS Exit 118 130 111.583759 $5579.1800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 9 17.000000 $1376.6600 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 11.000000 $890.7800 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 1.500000 $121.4700 $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 28 31 61.000000 $3655.1200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 19.000000 $1138.4800 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 22 30 60.000000 $4858.8000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 6 9 18.000000 $1457.6400 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 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
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.011111 $15.2800 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 6.000000 $348.6600 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 27.857143 $1618.7800 $58.1100
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Subtotal (Total Children Is Unduplicated) 261 368 494.672258 $30014.8200 $60.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 30 37 43.258751 $216294.0000 $5000.0100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.516667 $105.1800 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $694.8600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 345 391 400.883172 $20044.1600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 89 100 86.217355 $4310.8500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 51 53 78.704109 $1967.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 498 623 1429.180130 $71458.8500 $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 215 264 621.222212 $31061.0600 $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 294 349 874.138074 $43706.7900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 34 41 94.462554 $4723.1200 $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 166 196 1542.174607 $83277.4000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 37 43 315.038097 $17012.0800 $54.0000
INTR -T1013 INTERPRETER 254 322 669.702382 $33485.1200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2274 3610 26150.465482 $313805.5800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 11 13 94.504763 $7685.1300 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 6.066667 $493.3400 $81.3200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 6.142857 $499.5400 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 29 39 326.847621 $26579.2500 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 4 5 35.000000 $2846.2000 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.428571 $116.1700 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 2 3 1.444445 $331.6700 $229.6200
SENS -V5264 EARMOLD 4 5 6.477778 $117.4400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 38 42 319.014288 $25942.2400 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 7 42.038095 $3418.5400 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 13.700000 $892.1400 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 13.000000 $846.5600 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 52.000000 $4228.6400 $81.3200
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 26.000000 $409.7600 $15.7600
TRAV -TRAVS Travel by mile 2302 3675 26251.232152 $11681.8000 $0.4500
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Subtotal (Total Children Is Unduplicated) 2444 10249 60464.614622 $972689.2900 $16.0900
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Total 10799 61138.056719 $1002704.1100 $16.4000
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Number of Children (Unduplicated) With at Least One Authorization 2573