Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 07
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 6968 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 42 47 44.992857 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 42 47 44.992857 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
AUD -92626 EVAL OF AUD REHAB STATUS 68 71 45.194450 $2788.9800 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 91 97 105.180954 $1597.7000 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 53 63 43.605557 $935.7800 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 5 12.073809 $314.4000 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 12.890476 $208.1800 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 28 28 44.572221 $1082.2100 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 10 10 12.601587 $99.8000 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 36 38 83.977779 $2671.3400 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.000000 $99.1800 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 104 112 75.672223 $1149.4600 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 81 93 69.216671 $1601.6800 $23.1400
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 8.066667 $365.5800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.516667 $175.6500 $115.8100
EXIT -EXIT COS Exit 1 1 2.000000 $100.0000 $50.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 8.011111 $480.0300 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 28.000000 $1677.7600 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 8.011111 $648.7400 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 14 14 28.000000 $2267.4400 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 29 36 34.016667 $1976.7100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 95 102 60.927786 $3540.5600 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 5 7 2.494446 $144.9600 $58.1100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.766667 $44.5500 $58.1100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 11 5.550000 $322.5100 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 6 3.011112 $174.9800 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 47 50 33.816674 $1965.1300 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 2 0.505555 $29.3700 $58.1000
OCTH -97167TL OT EVAL HIGH COMPLEXITY 3 5 5.000000 $290.5500 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.505556 $29.3800 $58.1200
PSTF -97164 PT RE-EVAL EST PLAN CARE 25 31 25.311111 $1470.8300 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 3 3.000000 $174.3300 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 63 75 41.227782 $2395.7700 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 3.766667 $218.8800 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 0.944444 $54.8800 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 2 0.505556 $29.3800 $58.1200
PSTH -97163 PT EVAL HIGH COMPLEXITY 27 33 24.411113 $1418.5400 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 3 4 5.011112 $291.2000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 159 189 130.840487 $7603.2000 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 4 5 4.272222 $248.2600 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.505556 $29.3800 $58.1200
SPCH -92522 EVAL OF SPCH SOUND PROD 13 14 15.544444 $903.2900 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 2.000000 $116.2200 $58.1100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.505556 $29.3800 $58.1200
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 121 136 92.733341 $5388.7800 $58.1100
SPCH -92523GT 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 0.350000 $20.3400 $58.1100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.061111 $177.8800 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 32 41 34.377780 $1997.7100 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.505556 $145.6000 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 2.000000 $116.2200 $58.1100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $116.2200 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 35 44 557.140477 $32375.4300 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 2 13.000000 $755.4300 $58.1100
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Subtotal (Total Children Is Unduplicated) 871 1389 1706.200061 $83092.2100 $48.7000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 6 9 9.372223 $46861.5000 $5000.0400
AUD -92630 AUD REHAB PRELING HEARING LOSS 5 5 15.126984 $1049.0500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.288889 $20.0400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 14 15 26.505556 $6139.2300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 196 275 244.721639 $12236.1500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 33 39 36.005556 $1800.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 22 24 30.638890 $765.9800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 736 1011 2934.145212 $146707.1400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 15 17 41.700002 $2085.0100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 5 5 12.733333 $318.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 350 474 1239.296802 $61964.7300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 14 18 30.666666 $1533.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 2 2 1.666667 $41.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 183 231 627.198397 $31359.8500 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 11 13 29.266665 $1463.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 3 3 6.533333 $163.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 395 509 1175.729343 $58786.3500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 10 13 24.799999 $1240.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 1 1 0.500000 $12.5000 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 8.000000 $400.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1597 2079 19344.915894 $1044625.3900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 74 88 684.114286 $36942.1700 $54.0000
INTR -T1013 INTERPRETER 1 1 10.571429 $528.5700 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 127 157 1477.158727 $120122.5800 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 2 22.428571 $1823.8900 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 3 25.285715 $2056.2300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 26 30 284.780954 $18544.9300 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 9.714286 $632.6000 $65.1200
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 12.142857 $790.7500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 103 137 1357.995239 $110432.1600 $81.3200
PHY -97110HM PT SESSION BY PT ASST 4 5 28.066667 $1827.7000 $65.1200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 2 13.000000 $1057.1600 $81.3200
SENS -V5060 BEHIND EAR HEARING AID 2 2 3.011111 $691.3800 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 2.000000 $918.4400 $459.2200
SENS -V5260 IN EAR DIGITAL BINAURAL HEARING AID 1 1 1.011111 $1007.1500 $996.0800
SENS -V5264 EARMOLD 7 8 38.588889 $699.6200 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 248 310 2714.599998 $220751.3100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 5 36.571429 $2973.9900 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 19 21 204.428570 $13312.3900 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 5 6 57.142858 $3721.1400 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 4 4 40.714285 $3310.8900 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 2 13.000000 $1057.1600 $81.3200
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Subtotal (Total Children Is Unduplicated) 1773 5532 32876.139032 $1962775.3500 $59.7000
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Total 6968 34627.331950 $2045867.5600 $59.0800
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Number of Children (Unduplicated) With at Least One Authorization 1828