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: 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 4258 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 11 11 19.352380 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 60.666667 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 12 12 80.019047 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 90 105 76.004686 $3686.2400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 12 12 97.891629 $6040.8900 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.283333 $4.3000 $15.1900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.000000 $32.3000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 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 3 3 1.865297 $84.5400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 3.883334 $449.7400 $115.8100
EXIT -EXIT COS Exit 5 5 4.002740 $200.1400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $324.3700 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 2.005479 $120.1700 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 81 83 127.104101 $10292.9200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 24 24 47.000000 $3806.0600 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 59 62 121.500000 $9839.0700 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 14 14 28.000000 $2267.4400 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 121 131 222.604101 $13338.4600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 48 49 97.000000 $5812.2400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 86 112 222.000000 $17977.5600 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 32 48 96.000000 $7774.0800 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 6 0.726027 $42.1900 $58.1200
OCTH -97165 OT EVAL LOW COMPLEXITY 101 117 76.462030 $4443.2500 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 2 2.000000 $116.2200 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 41 49 27.250911 $1583.5400 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 7 9 3.474126 $201.8900 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.688889 $40.0300 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 0.452055 $26.2700 $58.1200
PSTH -97161 PT EVAL LOW COMPLEXITY 68 83 48.755636 $2833.2300 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 27 30 18.738205 $1088.8800 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 4 5 2.894445 $168.2000 $58.1100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.394444 $22.9200 $58.1000
SPCH -92521 EVAL OF SPEECH FLUENCY 108 125 80.379716 $4670.8900 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 4 1.022222 $59.4000 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 1.648413 $95.7900 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 15 17 11.997138 $697.1600 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 6 3.116438 $181.0900 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 4 2.249315 $130.7100 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 24 27 35.605479 $2069.0300 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.316667 $134.6200 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 3.505555 $203.7000 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 6 1.594445 $92.6600 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 2 12.857143 $747.1300 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 2 0.505556 $29.3800 $58.1200
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Subtotal (Total Children Is Unduplicated) 510 1193 1520.785034 $103432.0200 $68.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 91 107 358.840432 $1794201.5000 $5000.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 87 92 154.322153 $7716.0800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 18 19 24.438889 $1221.9500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 444 593 1177.671379 $58883.3100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 9 16.433332 $821.6600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 2 3 4.999999 $125.0000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 292 348 720.776160 $36038.6500 $50.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 13 14 15.933330 $796.6500 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 2 3.000000 $150.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 4 8.766666 $219.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 416 496 993.966622 $49698.1000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 3 5.733333 $286.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 7 10.928571 $273.2200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 443 556 4306.819053 $232568.2200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 52 62 433.571431 $23412.8500 $54.0000
INTR -T1013 INTERPRETER 26 39 84.750000 $4237.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 14 21 86.333332 $1036.0000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 186 225 1907.266665 $155098.9700 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 4 6 43.714286 $3554.8500 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 0.142857 $11.6200 $81.3400
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 5.285714 $429.8300 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 109 129 1111.828573 $90413.9300 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 2 2 2.285714 $185.8800 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 4 6 46.714286 $3798.8000 $81.3200
PHY -97110HM PT SESSION BY PT ASST 10 11 100.857142 $6567.8200 $65.1200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.377778 $86.7500 $229.6200
SENS -V5060 BEHIND EAR HEARING AID 2 3 1.004186 $230.5700 $229.6100
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.498630 $489.0000 $980.6800
SENS -V5264 EARMOLD 4 5 2.885464 $52.3100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 189 223 1967.766408 $160018.7600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 16 17 126.461904 $10283.8900 $81.3200
TRAV -TRAVS Travel by mile 24 47 3890.780950 $1731.4000 $0.4500
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Subtotal (Total Children Is Unduplicated) 672 3053 17615.155239 $2644640.8800 $150.1300
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Total 4258 19215.959320 $2748072.9000 $143.0100
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Number of Children (Unduplicated) With at Least One Authorization 809