Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 10-01-25 and 12-31-25 Date of Report: 01-07-26 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 10303 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 162 180 170.066663 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 162 180 170.066663 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 30 35 29.568494 $1434.0700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 15.412329 $951.0900 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 33 33 76.581746 $1163.2800 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 3 2.766667 $59.3700 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 4 3.766667 $98.0800 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 2 2.000000 $32.3000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 13 14 24.052381 $583.9900 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 6 5.766667 $45.6700 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 3 2.766667 $88.0100 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.766667 $38.0200 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 3 2.766667 $42.0300 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 17 18 23.338096 $540.0400 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.166667 $9.1500 $54.9100
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 8.714286 $681.8900 $78.2500
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 1.644444 $133.5900 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 7.428571 $336.6600 $45.3200
EXIT -EXIT COS Exit 143 146 123.191259 $6159.5600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 8 15 30.000000 $2250.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 12.000000 $971.7600 $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 -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 12 24.000000 $1438.0800 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 8.000000 $479.3600 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 17 26 44.021916 $3564.9000 $80.9800
IPDEF -T1024TSTLGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 78 87 174.000000 $14090.5200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 17 20 36.500000 $2955.7700 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 15 16 32.000000 $2591.3600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 6 6 11.500000 $931.2700 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 35 35 70.000000 $5668.6000 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 11 12 22.500000 $1822.0500 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 237 251 509.714286 $30542.0800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 116 137 263.005479 $15759.2900 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 203 246 490.000000 $39680.2000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 102 142 301.505479 $24415.9200 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 4.000000 $232.4400 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 18 19 37.777778 $2195.2700 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 7 7 73.209524 $4254.2100 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 9.142857 $531.2900 $58.1100
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Subtotal (Total Children Is Unduplicated) 742 1342 2504.575594 $168265.9400 $67.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 19 22 20.212481 $101063.0000 $5000.0300
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 9.714286 $673.6900 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 251 259 291.919113 $14595.9500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 62 66 55.350914 $2767.5300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 41 39.995598 $999.8900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 299 401 884.117863 $44206.0100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 49 64 201.477781 $10073.9100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 12 15 35.666668 $891.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 88 102 220.838158 $11041.9500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 19 22 54.700000 $2735.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 8 10 25.700001 $642.5000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 105 131 261.878859 $13094.0200 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 17 19 39.933335 $1996.6800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 4 5 11.066666 $276.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 142 171 351.996040 $17599.8500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 20 21 47.866666 $2393.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 15 16 61.281803 $1532.0600 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 2 13.142857 $657.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1379 1728 14078.523674 $760241.0900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 186 223 1765.219026 $95321.9600 $54.0000
INTR -T1013 INTERPRETER 237 331 782.935708 $39146.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1607 2407 18019.129479 $216229.8100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 30 40 256.028570 $20820.2500 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 6.133333 $498.7600 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 76 95 758.261897 $61661.9100 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 4 5 65.714285 $5343.8900 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 13.142857 $1068.7800 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 4 4 45.714285 $3717.4900 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 3 4 35.428571 $2881.0500 $81.3200
RSPT -RSPT RESPITE 1 1 13.142857 $0.0000 $0.0000
SENS -V5264 EARMOLD 1 1 1.644444 $29.8100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 74 89 560.014277 $45540.4200 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 9 9 71.380952 $5804.7200 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 91.999999 $5991.0500 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 3 3 39.571428 $3217.9500 $81.3200
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 1 1 3.285714 $213.9600 $65.1200
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 9.428571 $148.5900 $15.7600
TRAN -TRAN *FAMILY TRANSPORTATION 2 2 16.209524 $1620.9600 $100.0000
TRAV -TRAVS Travel by mile 1625 2456 18084.525511 $8047.6200 $0.4500
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Subtotal (Total Children Is Unduplicated) 1746 8781 57349.294051 $1505783.5800 $26.2600
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Total 10303 60023.936308 $1674049.5200 $27.8900
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Number of Children (Unduplicated) With at Least One Authorization 1975