Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
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 2634 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 8 8 22.624604 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 8 8 22.624604 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 25 30 23.289954 $1129.5700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 6 2.896499 $178.7400 $61.7100
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 3 3 2.252055 $36.3700 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 6 5.252055 $127.5200 $24.2800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 3.570777 $161.8300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.133333 $131.2500 $115.8100
EXIT -EXIT COS Exit 11 11 8.974962 $448.7500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 3.500000 $262.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $323.9200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $359.5200 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $119.8400 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 5 5 10.000000 $809.8000 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 44 44 52.098622 $4218.9800 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 9.500000 $769.3100 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 32 32 62.000000 $5020.7600 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 18 18 36.000000 $2915.2800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 103 110 193.741479 $11609.0200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 40 42 83.000000 $4973.3600 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 65 77 154.000000 $12470.9200 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 15 16 32.000000 $2591.3600 $80.9800
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.216438 $12.5800 $58.1000
OCTH -97165 OT EVAL LOW COMPLEXITY 48 56 41.966895 $2438.6900 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 18 19 11.428616 $664.1300 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 5 6 2.911111 $169.1600 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 1.252055 $72.7600 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 33 39 24.113089 $1401.2000 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 15 16 13.720016 $797.2700 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 2 0.511111 $29.7000 $58.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 49 55 38.872679 $2258.9000 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 2.438889 $141.7200 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $58.1100 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 0.577701 $33.5700 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 3 3 1.352055 $78.5700 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.104110 $6.0500 $58.1000
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.511111 $29.7000 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 6.000000 $348.6600 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.511111 $87.8100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 4 0.763166 $44.3400 $58.1000
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 0.511111 $29.7000 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 4 26.285714 $1527.4600 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 2 0.511111 $29.7000 $58.1100
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Subtotal (Total Children Is Unduplicated) 314 651 874.767825 $59092.7100 $67.5500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 27 52.236334 $261182.5000 $5000.0200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 59 66 112.174663 $5608.7500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 11 12 15.733333 $786.6700 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 338 448 953.019094 $47651.1700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 5 5 8.119048 $405.9600 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 190 224 474.028593 $23701.5500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 2 2 3.816667 $190.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 8.200001 $205.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 25 30 59.633337 $2981.6900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 1 2 3.066667 $153.3400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 9 11.966668 $299.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 313 369 769.148452 $38457.6200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 2 3 6.133334 $306.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 16.633335 $415.8400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 322 392 3258.871400 $175979.3100 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 59 73 617.071423 $33321.9100 $54.0000
INTR -T1013 INTERPRETER 21 32 60.500000 $3025.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 2 2 22.000000 $264.0000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 82 93 802.447610 $65255.1600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 3 4 39.428571 $3206.3300 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 1 1 11.000000 $894.5200 $81.3200
PHY -97110 PT SESSION BY LICENSED PT 48 54 494.557137 $40217.4600 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 1 1 1.000000 $81.3200 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 1 1 11.000000 $894.5200 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 3 5 51.285714 $4170.5500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 4 4 44.571428 $2902.5000 $65.1200
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.133333 $30.6100 $229.5500
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.504110 $115.7500 $229.6100
SENS -V5264 EARMOLD 2 2 1.156164 $20.9600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 76 86 706.571424 $57458.4600 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 7 66.714285 $5425.2100 $81.3200
TRAV -TRAVS Travel by mile 5 10 506.000000 $225.1700 $0.4500
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Subtotal (Total Children Is Unduplicated) 447 1975 9188.722125 $775835.4800 $84.4300
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Total 2634 10086.114554 $834928.1900 $82.7800
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Number of Children (Unduplicated) With at Least One Authorization 554