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
Eligibility Filter: Program Patients
With the filters selected there were 14738 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 204 225 239.082535 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 204 225 239.082535 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 67 85 74.116137 $3594.6400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 17 19 27.012328 $1666.9200 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 48 50 108.130952 $1642.5100 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 3 2.766667 $59.3700 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 6 5.766667 $150.1600 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 2 2.000000 $32.3000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 18 19 29.052381 $705.3900 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 8 7.766667 $61.5100 $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) 24 25 37.909525 $877.2300 $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 2 3 2.155555 $175.1100 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 7 13.428571 $608.5800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 2.642618 $306.0400 $115.8100
EXIT -EXIT COS Exit 194 199 170.441259 $8522.0600 $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 7 7 14.000000 $1133.7200 $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 16 16 32.000000 $1917.4400 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 10.000000 $599.2000 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 23 34 60.021916 $4860.5800 $80.9800
IPDEF -T1024TSTLGT F/U PHYC AND DEV EVAL BY EI PROF 2 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 94 108 216.000000 $17491.6800 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 26 30 56.000000 $4534.8800 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 22 23 46.000000 $3725.0800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 9 9 17.500000 $1417.1500 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 45 45 88.066667 $7131.6400 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 12 13 24.500000 $1984.0100 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 331 356 711.791911 $42650.5800 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 135 159 307.005479 $18395.7700 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 293 354 703.010958 $56929.8300 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 120 166 349.005479 $28262.4700 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 9 10 10.000000 $581.1000 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 5 5.000000 $290.5500 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 2.000000 $116.2200 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 6 7.000000 $406.7700 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97162TL 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
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.233333 $18.6400 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 30 31 51.634921 $3000.5000 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 4 4 4.000000 $232.4400 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 2 2.000000 $116.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.213699 $128.6400 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 14 16 134.780952 $7832.1300 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 4 5 56.000000 $3254.1600 $58.1100
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Subtotal (Total Children Is Unduplicated) 1040 1885 3465.135596 $230399.1100 $66.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 52 71 54.112788 $270566.5000 $5000.0500
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 10.714286 $743.0400 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 4 1.861111 $129.0700 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 12 13 15.504110 $3591.0600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 363 401 446.724413 $22336.2200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 94 106 83.006396 $4150.2900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 48 50 49.445598 $1236.1400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 441 598 1274.606761 $63730.5000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 64 86 244.877783 $12243.9200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 16 19 45.800002 $1145.0100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 139 169 398.403243 $19920.2400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 25 28 72.666668 $3633.3400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 9 11 26.633334 $665.8400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 183 233 470.873308 $23543.7700 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 28 35 79.159949 $3958.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 6 7 17.200000 $430.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 237 295 680.906362 $34045.3900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 31 34 75.478995 $3773.9500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 25 27 84.626249 $2115.6700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 9 53.504761 $2675.2400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1797 2277 18260.279191 $986056.2200 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 274 334 2560.090446 $138245.0400 $54.0000
INTR -T1013 INTERPRETER 256 353 857.630945 $42881.5900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2185 3419 25014.746084 $300177.3200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 56 75 442.123806 $35953.5300 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 3 11.999999 $975.8300 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 8.000000 $520.9600 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $1068.7800 $81.3200
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 12.142857 $790.7500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 146 193 1478.407921 $120224.2800 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 5 6 70.857142 $5762.1200 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 2 2 21.142857 $1719.3400 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 5 5 47.571428 $3868.5100 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 5 7 52.971428 $4307.6300 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 13.142857 $1068.7800 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 9.285714 $755.1100 $81.3200
RSPT -RSPT RESPITE 1 1 13.142857 $0.0000 $0.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.8100 $114.8100
SENS -V5060 BEHIND EAR HEARING AID 4 6 6.015221 $1381.1500 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 2.000000 $918.4400 $459.2200
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 2.000000 $1961.4800 $980.7400
SENS -V5264 EARMOLD 10 14 14.658599 $265.7600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 158 202 1465.480934 $119173.0600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 16 17 107.933333 $8777.1400 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 8 98.999999 $6446.8900 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 9 9 92.704760 $7538.7500 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 2 13.142857 $1068.7800 $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 4 4 25.285713 $398.5000 $15.7600
TRAN -TRAN *FAMILY TRANSPORTATION 2 2 16.209524 $1620.9600 $100.0000
TRAV -TRAVS Travel by mile 2207 3482 25073.573863 $11157.7500 $0.4500
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Subtotal (Total Children Is Unduplicated) 2352 12628 79995.075023 $2280046.3800 $28.5000
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Total 14738 83699.293154 $2510445.4900 $29.9900
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Number of Children (Unduplicated) With at Least One Authorization 2661