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 3405 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 104 110 5030.198411 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 25 26 8222.116666 $305862.7400 $37.2000
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Subtotal (Total Children Is Unduplicated) 129 136 13252.315077 $305862.7400 $23.0800
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 2 2 0.230528 $17.3000 $75.0200
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 13 26.000000 $2105.4800 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 5 5 8.000000 $647.8400 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 8.000000 $647.8400 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 11 11 21.000000 $1258.3200 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $239.6800 $59.9200
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 56 56 111.000000 $8988.7800 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 14.000000 $1133.7200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 18 18 36.000000 $2915.2800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 28 28 56.000000 $4534.8800 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 5 5 10.000000 $809.8000 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 42 42 84.000000 $5033.2800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 17 17 32.285714 $1934.5600 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 39 40 28.034493 $1629.1300 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 2.516668 $146.2500 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 20 20 16.916666 $983.0200 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 23 25 8.622227 $501.0600 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 3 3 0.766667 $44.5500 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 2 2 1.038889 $60.3700 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 10 12 7.033335 $408.7200 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 0.644445 $37.4500 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 49 53 17.577783 $1021.4700 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 15.027778 $873.2700 $58.1100
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Subtotal (Total Children Is Unduplicated) 251 383 522.595193 $36815.9500 $70.4500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 1 1 1.000000 $5000.0000 $5000.0000
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 406 497 341.193633 $17059.5900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 6 3.144445 $157.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 289 357 475.314282 $11882.8500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 186 379 264.749984 $13237.4200 $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 352 438 292.045223 $14602.1800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 4 4 2.166667 $108.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 275 343 452.247610 $11306.1700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 171 213 1830.885720 $98867.8100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 16 19 176.857143 $9550.2800 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 34 36 308.428572 $25081.4200 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 39 46 431.285715 $28085.3200 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 9.285714 $604.6800 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 21 22 195.857144 $15927.1000 $81.3200
PHY -97110HM PT SESSION BY PT ASST 16 20 203.500000 $13251.9300 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 2 2 1.450000 $26.2900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 78 87 693.261910 $56376.0200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 43.000000 $3496.7500 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $185.8700 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 5.142857 $418.2200 $81.3200
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Subtotal (Total Children Is Unduplicated) 724 2886 6203.835664 $339781.2000 $54.7700
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Total 3405 19978.745934 $682459.8900 $34.1600
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Number of Children (Unduplicated) With at Least One Authorization 882