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 10271 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 176 194 209.169837 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 176 194 209.169837 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 53 69 53.364082 $2588.1600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 5 10.000000 $617.1000 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 5 9.066667 $137.7200 $15.1900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 4.000000 $97.1200 $24.2800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 10.571429 $244.6200 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.166667 $9.1500 $54.9100
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 3 2.155555 $175.1100 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 5 5.000000 $226.6000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 1.511111 $175.0000 $115.8100
EXIT -EXIT COS Exit 174 179 154.907926 $7745.4000 $50.0000
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 1 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TSTLGT F/U PHYC AND DEV EVAL BY EI PROF 1 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 3.500000 $283.4300 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 2 4.000000 $323.9200 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 20 21 42.000000 $2516.6400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 7 8 16.000000 $958.7200 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 16 20 41.000000 $3320.1800 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 12 17 33.500000 $2712.8300 $80.9800
OCTH -97165 OT EVAL LOW COMPLEXITY 4 5 5.000000 $290.5500 $58.1100
OCTH -97166GT OT EVAL MODERATE 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 1 1 1.000000 $58.1100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 2.000000 $116.2200 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.233333 $3.5300 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 7.000000 $406.7700 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 2 2.000000 $116.2200 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 6.000000 $348.6600 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 2 13.142857 $763.7300 $58.1100
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Subtotal (Total Children Is Unduplicated) 293 385 453.119627 $26249.5000 $57.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 31 23.933030 $119665.5000 $5000.0100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.350000 $24.2700 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 362 400 445.724413 $22286.2200 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 92 104 82.500917 $4125.0200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 48 50 49.445598 $1236.1400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 440 597 1271.706761 $63585.5000 $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 4 7 40.361904 $2018.1000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 145 172 1380.509511 $74547.6100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 36 44 332.561903 $17958.3600 $54.0000
INTR -T1013 INTERPRETER 233 321 739.461899 $36973.1200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2185 3419 25014.746084 $300177.3200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 9 11 61.514287 $5002.3600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 2 9.066666 $737.3000 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 1 1 8.000000 $520.9600 $65.1200
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 12.142857 $790.7500 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 27 38 305.695237 $24859.1700 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 8.000000 $650.5600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 10.285714 $836.4300 $81.3200
PHY -97110TL PT SESSION BY LICENSED PT 1 1 13.142857 $1068.7800 $81.3200
RSPT -RSPT RESPITE 1 1 13.142857 $0.0000 $0.0000
SENS -V5060 BEHIND EAR HEARING AID 2 3 1.511111 $346.9600 $229.6100
SENS -V5264 EARMOLD 3 5 5.211111 $94.4800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 34 45 346.028568 $28139.0700 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 17.000000 $1382.4400 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.428571 $223.2700 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 39.428571 $3206.3300 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 2 13.142857 $1068.7800 $81.3200
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 2206 3480 25069.145292 $11155.7800 $0.4500
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Subtotal (Total Children Is Unduplicated) 2321 9692 57540.452564 $830156.8400 $14.4300
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Total 10271 58202.742028 $856406.3400 $14.7100
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Number of Children (Unduplicated) With at Least One Authorization 2467