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: 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 4957 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 87 101 4283.609522 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 112 124 46270.527778 $2113637.7100 $45.6800
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Subtotal (Total Children Is Unduplicated) 199 225 50554.137300 $2113637.7100 $41.8100
Screening, Eval, and Assessment, Class # 02
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 1.022222 $118.3800 $115.8100
EXIT -EXIT COS Exit 1 2 2.000000 $100.0000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 10 10 14.581051 $1093.5800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 56 58 90.728539 $7347.1900 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 18 18 25.657230 $2077.7400 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 10.011111 $810.7000 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $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 17 17 22.392770 $1341.7700 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 10 10 12.273973 $735.4500 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $161.9600 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 325 332 664.000000 $53770.7200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 20 20 40.000000 $3239.2000 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 147 148 296.000000 $23970.0800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 17 17 34.000000 $2753.3200 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 98 98 196.000000 $15872.0800 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 67 68 136.000000 $8149.1200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 13 13 26.000000 $1557.9200 $59.9200
OCTF -97168 OT RE-EVAL EST PLAN CARE 103 127 47.601365 $2766.0900 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 2 3 0.527778 $30.6700 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 3 4 1.372222 $79.7400 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 2.511111 $145.9200 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 52 67 40.521381 $2354.6800 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 3.000000 $174.3300 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 47 52 17.942845 $1042.6600 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 3 3 1.011111 $58.7600 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 0.483333 $28.0800 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 11 12 11.483333 $667.2900 $58.1100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 4 2.422222 $36.6000 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 18 20 28.749999 $1670.6600 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 0.516667 $30.0300 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.466667 $27.1200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 151 173 103.248911 $5999.7900 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 8 9 5.888888 $342.2000 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.422222 $24.5300 $58.1100
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Subtotal (Total Children Is Unduplicated) 743 1310 1852.836951 $139491.5800 $75.2900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 2 2 2.000000 $10000.0000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 3.044444 $705.1400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 16 17 19.650001 $982.5100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 5 5 5.000000 $250.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 2 2 1.211111 $30.2800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 393 456 332.209493 $16610.3300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 6 7 3.255555 $162.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 254 297 366.052372 $9151.2900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 153 311 221.688873 $11084.3700 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 1 1 0.277778 $13.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 78 163 223.533330 $5588.3300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 44 98 58.811102 $2940.5100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 23 54 62.466668 $1561.6700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 349 404 303.120602 $15155.8700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 4 6 5.588889 $279.4500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 235 276 351.266661 $8781.6500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 456 537 4542.061862 $245271.7600 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 32 40 305.999999 $16524.0300 $54.0000
OCCT -97530 OT SESSION BY LICENSED OT 84 109 915.338885 $74435.4600 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 1 1 7.000000 $569.2400 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 121 149 1465.030945 $95402.9000 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 5 8 57.857142 $3767.6700 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 56 63 722.142852 $58724.7700 $81.3200
PHY -97110HM PT SESSION BY PT ASST 53 66 617.857140 $40234.8700 $65.1200
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.022222 $234.7100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $459.2200 $459.2200
SENS -V5264 EARMOLD 4 5 2.933333 $53.1800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 254 321 2369.225373 $192665.6100 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 8 8 92.857141 $7551.1600 $81.3200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 6 36.185714 $2942.6200 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 4 27.571429 $2242.1100 $81.3200
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Subtotal (Total Children Is Unduplicated) 953 3422 13123.260916 $824377.3400 $62.8200
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Total 4957 65530.235167 $3077506.6200 $46.9600
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Number of Children (Unduplicated) With at Least One Authorization 1217