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 2130 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 50 57 45.047229 $2184.7900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 3.380518 $208.6100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 0.283333 $4.3000 $15.1900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $16.1500 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.000000 $48.5600 $24.2800
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 1.000000 $78.2500 $78.2500
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.377778 $43.7500 $115.8200
EXIT -EXIT COS Exit 4 4 3.002740 $150.1400 $50.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 12 12 10.038353 $812.9200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $647.8400 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 10 10 19.500000 $1579.1100 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 5 5 10.000000 $809.8000 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 26 26 38.038353 $2279.2700 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 11 11 22.000000 $1318.2400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 28 38 75.000000 $6073.5000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 14 22 44.000000 $3563.1200 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.249315 $14.4900 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 9 11 5.504186 $319.8500 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 6 1.502815 $87.3200 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.002740 $0.1600 $57.2600
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 1.622223 $94.2700 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 0.750685 $43.6200 $58.1000
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.083333 $4.8400 $58.0900
SPCH -92521 EVAL OF SPEECH FLUENCY 8 9 5.040944 $292.9300 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 2 0.505555 $29.3700 $58.1000
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.142857 $66.4100 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 8.927201 $518.7600 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $116.2200 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.083333 $4.8400 $58.0900
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Subtotal (Total Children Is Unduplicated) 138 249 314.083491 $21647.5000 $68.9200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 14 16 46.434410 $232172.5000 $5000.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 87 92 154.322153 $7716.0800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 15 16 18.938889 $946.9500 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 441 589 1170.204713 $58509.9800 $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 283 335 697.976162 $34898.6600 $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 410 486 980.266623 $49013.1100 $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 95 118 937.942854 $50648.9300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 10 12 69.142858 $3733.7100 $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 19 22 181.428571 $14753.7700 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 7 8 65.285714 $5309.0400 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 2.142857 $174.2600 $81.3200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.377778 $86.7500 $229.6200
SENS -V5264 EARMOLD 1 1 1.133333 $20.5500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 18 20 161.590215 $13140.5200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 6.319047 $513.8700 $81.3200
TRAV -TRAVS Travel by mile 24 47 3890.780950 $1731.4000 $0.4500
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Subtotal (Total Children Is Unduplicated) 550 1869 8621.165690 $481315.9100 $55.8300
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Total 2130 9015.268228 $502963.4100 $55.7900
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Number of Children (Unduplicated) With at Least One Authorization 622