Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 55
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 5723 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 109 116 5928.142855 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 124 138 49158.486508 $1828695.7000 $37.2000
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Subtotal (Total Children Is Unduplicated) 231 254 55086.629363 $1828695.7000 $33.2000
Screening, Eval, and Assessment, Class # 02
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 2.000000 $15.8400 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 2.000000 $63.6200 $31.8100
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.900000 $104.2300 $115.8100
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 4.230528 $317.3000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 63 65 110.992162 $8988.1500 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 16 16 22.152131 $1793.8900 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 15.000000 $1214.7000 $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 16 16 32.000000 $2591.3600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 27 27 45.454946 $2723.6600 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 7 14.000000 $838.8800 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.317808 $25.7400 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 321 321 636.571428 $51549.5500 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 46 47 94.000000 $7612.1200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 71 71 142.000000 $11499.1600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 14 14 26.066667 $2110.8800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 114 114 226.285714 $18324.6200 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 11 11 22.000000 $1781.5600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 125 125 250.000000 $14980.0000 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 51 51 100.285714 $6009.1200 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 117 139 69.371005 $4031.2100 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.177778 $10.3300 $58.1200
OCTH -97165 OT EVAL LOW COMPLEXITY 3 4 1.788889 $103.9500 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 12 6.188891 $359.6500 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 85 89 63.983339 $3718.1000 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 5 5 6.000000 $348.6600 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 73 85 30.753811 $1787.1400 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 4 4 1.088889 $63.2800 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 4.777778 $277.6400 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 19 19 14.188204 $824.4800 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.738204 $11.1500 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 28 31 106.066670 $6163.5500 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 1.055556 $61.3400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 184 208 127.519018 $7410.2200 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 15.972223 $928.1500 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.133333 $182.0800 $58.1100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $58.1100 $58.1100
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Subtotal (Total Children Is Unduplicated) 835 1526 2206.060686 $159277.8000 $72.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.500000 $347.4300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 14 19 18.134920 $906.7400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 4 5 4.000000 $200.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 7 7 5.661111 $141.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 412 505 345.493634 $17274.6000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 6 3.144445 $157.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 290 358 475.592060 $11889.7900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 189 383 266.627762 $13331.3100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.611111 $30.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 99 204 281.887305 $7047.1900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 53 118 78.544437 $3927.1900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 2 2 2.022222 $101.1100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 24 51 78.872225 $1971.8100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 355 441 293.323002 $14666.0800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 4 4 2.166667 $108.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 276 344 452.525388 $11313.1100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 462 579 4866.785728 $262806.4300 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 40 44 350.000002 $18900.0000 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 104 126 1081.376986 $87937.5900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 145 188 1792.535720 $116729.9000 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 13.857143 $902.3700 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 66 76 704.142856 $57260.9100 $81.3200
PHY -97110HM PT SESSION BY PT ASST 75 101 943.792860 $61459.7900 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 2 2 8.857143 $576.7700 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.249315 $286.8500 $229.6100
SENS -V5264 EARMOLD 4 4 2.950000 $53.4800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 268 325 2509.733341 $204091.4700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 10 13 125.428572 $10199.8500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 19 23 148.509522 $12076.7900 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 6 29.571429 $2404.7500 $81.3200
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Subtotal (Total Children Is Unduplicated) 1015 3943 14890.896906 $929100.9500 $62.3900
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Total 5723 72183.586955 $2917074.4400 $40.4100
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Number of Children (Unduplicated) With at Least One Authorization 1307