Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Statewide
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 47282 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 658 736 2983.472212 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.022222 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 143 156 38721.811109 $1768812.3200 $45.6800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 801 893 41706.305543 $1768812.3200 $42.4100
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 8 9 8.544444 $998.2400 $116.8300
AACIS -92597TL AAC INTIAL EVAL BY LICENSED SLP 2 2 2.000000 $233.6600 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 134 158 118.769559 $5760.3300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 93 102 115.372317 $7119.6100 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 97 100 138.314284 $2100.9900 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 819 854 840.931201 $18046.3800 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 4 3.766667 $98.0800 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 786 819 813.827702 $13143.3200 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 111 117 105.571099 $2563.2600 $24.2800
AUDE -92558 OTOACOUSTIC EMISSIONS (SCREENING) 22 22 22.000000 $151.1400 $6.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 763 793 789.586759 $6253.5300 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 25 25 25.000000 $272.0000 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 769 800 813.896282 $25890.0400 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.766667 $87.6100 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 74 78 59.688886 $906.6700 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 816 849 841.702631 $19477.0000 $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 39 43 36.908078 $1672.6800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 20 23 22.400000 $2594.1400 $115.8100
EXIT -EXIT COS Exit 280 285 260.166221 $13008.3100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 21 29 53.825495 $4036.9100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 50 50 74.395206 $6024.5200 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 18 18 26.920700 $2180.0500 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 15.011111 $1215.6000 $80.9800
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $80.9800
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 10.022222 $811.6000 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 0.504110 $40.8200 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 46 46 76.387214 $4577.1200 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 24 24 29.822527 $1786.9600 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 23 32 56.021916 $4536.6600 $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 395 408 777.598622 $62969.9700 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 63 66 152.285714 $12332.1000 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 129 130 258.000000 $20892.8400 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 57 57 113.000000 $9150.7400 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 130 131 261.500000 $21176.2700 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 21 22 42.000000 $3401.1600 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 438 460 926.955764 $55543.2200 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 255 278 543.505479 $32566.8500 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 273 328 654.000000 $52960.9200 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 120 161 339.505479 $27493.1600 $80.9800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 39 50 194.674604 $9733.7300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 11 82.571427 $4128.5800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 104 133 78.305106 $4550.2900 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.027778 $1.6200 $58.1600
OCTH -97165 OT EVAL LOW COMPLEXITY 191 211 168.376415 $9784.3300 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 8 8 5.300001 $307.9900 $58.1100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.266667 $15.5000 $58.1200
OCTH -97166 OT EVAL MODERATE COMPLEXITY 59 61 51.500838 $2992.7300 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 8 9 5.355555 $311.2100 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 3 3 1.307611 $75.9900 $58.1100
OCTH -97167 OT EVAL HIGH COMPLEXITY 138 175 120.838887 $7021.9400 $58.1100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 8 9 6.383333 $370.9300 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 56 66 23.749994 $1380.0800 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 1.327778 $77.1600 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 50 57 41.225505 $2395.6100 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 1.316667 $76.5100 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 98 113 92.835309 $5394.6400 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97161TL PT EVAL LOW COMPLEXITY 3 3 2.100000 $122.0300 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 26 27 24.216841 $1407.2400 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 4 2.022222 $117.5100 $58.1100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 3 0.650000 $37.7700 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 78 91 59.794442 $3474.6400 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 7 8 4.916666 $285.7000 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 54 61 23.866663 $1386.8700 $58.1100
SCREEN-T1023 SCREENING 26 28 28.022222 $1512.6400 $53.9800
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.377778 $5.7100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 227 246 229.562359 $13339.8600 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 15 17 8.577778 $498.4600 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 64 72 43.520632 $2528.9700 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.205556 $11.9500 $58.1200
SPCH -92522 EVAL OF SPCH SOUND PROD 15 16 13.249924 $769.9600 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 3 3 1.352055 $78.5700 $58.1100
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 3 1.037443 $60.2800 $58.1100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.511111 $29.7000 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 280 318 244.959202 $14234.5500 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 3.172222 $184.3400 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 6.455555 $375.1300 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 29 32 42.471101 $2467.9800 $58.1100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 7 3.461111 $201.1200 $58.1100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $58.1100 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 107 123 1159.807924 $67396.5000 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 12 14 83.230158 $4836.5000 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3953 9357 12314.904193 $609645.9400 $49.5000
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 10 11 12.222222 $585.9300 $47.9400
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 0.333333 $15.9800 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 127 154 185.956576 $929784.0000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 32 47 82.004766 $5687.0600 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.133333 $78.5900 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 23 24 28.044444 $6495.6400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 911 1175 1211.792401 $60589.6400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 175 188 176.921722 $8846.0600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 144 157 160.986933 $4024.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2283 2958 6085.052253 $304253.0600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 166 205 462.336516 $23116.8600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 186 227 307.669046 $7691.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1165 1504 2968.742151 $148437.2800 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 118 139 236.518259 $11825.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 75 145 228.999999 $5725.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 619 813 1637.000107 $81850.1000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 86 106 197.590483 $9879.5500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 32 59 73.533336 $1838.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1612 1903 3186.674200 $159333.8500 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 137 160 261.980957 $13099.0700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 195 235 381.170694 $9529.2800 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 40.000000 $1000.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 275 336 2826.182515 $76307.0700 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 3 5 15.642857 $782.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10300 12923 106305.487562 $5740503.0800 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 541 657 5055.819794 $273014.6700 $54.0000
INTR -T1013 INTERPRETER 337 491 1695.171421 $84758.6100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3220 4415 35467.524559 $425610.8200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 954 1181 8349.036485 $678944.1400 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 31 33 126.242064 $10266.0100 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 14 15 39.325398 $3197.9400 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 5 6 53.285714 $4333.1900 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 149 190 1704.719036 $111011.4100 $65.1200
OCCT -97530HMGT OT SESSION BY OT ASST 4 6 44.714285 $2911.8000 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 202 245 1443.015068 $117346.1600 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 85 98 421.695236 $34292.2700 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
OCCT -97530TLGTHM OT SESSION BY OT ASST 2 2 11.142857 $725.6300 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 16 24 64.215078 $4181.7000 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 908 1124 7596.196847 $617723.1400 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 29 34 238.614284 $19404.1400 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 8 9 93.190477 $7578.2600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 16 18 143.088888 $11636.0100 $81.3200
PHY -97110HM PT SESSION BY PT ASST 78 96 813.811899 $52995.4600 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 3 5 32.571429 $2121.0500 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 200 240 1370.061109 $111413.4400 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 2 3 13.428572 $1092.0100 $81.3200
PHY -97110TLGT PT SESSION BY LICENSED PT 2 3 20.428571 $1661.2500 $81.3200
RSPT -RSPT RESPITE 1 1 13.142857 $0.0000 $0.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 2.133333 $489.8300 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 14 18 19.504110 $4478.3400 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 1.755556 $806.2100 $459.2300
SENS -V5264 EARMOLD 33 44 66.037120 $1197.2600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1353 1651 11435.942907 $929971.5300 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 57 63 509.756346 $41453.4500 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 23 25 242.428573 $15786.9500 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 4 4 24.071429 $1567.5300 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 300 350 1654.411106 $134536.7800 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 9 11 35.304762 $2870.9900 $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 1641 2480 18680.739797 $8312.9300 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 12894 37032 224585.498870 $11330960.1300 $50.4500
-------------------------------------------------------------------------------------------------------------------------------------
Total 47282 278606.708606 $13709418.3900 $49.2100
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 13945