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 19923 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 608 679 2897.435703 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.022222 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 13 14 4269.422223 $195027.2100 $45.6800
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Subtotal (Total Children Is Unduplicated) 622 694 7167.880148 $195027.2100 $27.2100
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 3 4 3.544444 $414.0900 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 123 146 108.029528 $5239.4300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 10 11.855555 $731.6000 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 4 4 5.088889 $77.3000 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 34 36 35.577777 $763.5000 $21.4600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 28 30 30.000000 $484.5000 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 9 8.194444 $198.9600 $24.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 27 29 29.000000 $229.6800 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 28 30 42.142857 $1340.5700 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $49.5900 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 1.355555 $20.5900 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 33 36 38.810318 $898.0700 $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 1 1 1.644444 $133.5900 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 9 13.273809 $601.5700 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 2.888889 $334.5600 $115.8100
EXIT -EXIT COS Exit 274 279 256.132888 $12806.6400 $50.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 2.011111 $162.8600 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $161.9600 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 10.000000 $599.2000 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 1.011111 $60.5900 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 2 3 6.000000 $485.8800 $80.9800
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 27 27 54.000000 $4372.9200 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $323.9200 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 18.000000 $1457.6400 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $647.8400 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 26.000000 $2105.4800 $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 15 15 32.285714 $1934.5600 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 10 10 20.000000 $1198.4000 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 5 10.000000 $809.8000 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 8 13 26.000000 $2105.4800 $80.9800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 19 26 72.414287 $3620.7200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 18.285714 $914.2900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 16 17 7.671537 $445.7900 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 7.077778 $411.2900 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 0.205556 $11.9500 $58.1200
OCTH -97167 OT EVAL HIGH COMPLEXITY 16 21 14.611111 $849.0500 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 6 6 2.338888 $135.9100 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 9 9 2.454870 $142.6500 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 5 3.238889 $188.2100 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 9 11 9.666666 $561.7300 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.172222 $10.0100 $58.1000
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 3 0.811111 $47.1300 $58.1100
SCREEN-T1023 SCREENING 1 1 1.000000 $53.9800 $53.9800
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.377778 $5.7100 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 19 20 18.488889 $1074.3900 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.205556 $11.9500 $58.1200
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.350000 $20.3400 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 42 46 37.736615 $2192.8700 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.511111 $29.7000 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 19 22 234.152379 $13606.6100 $58.1100
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Subtotal (Total Children Is Unduplicated) 661 954 1246.784957 $65592.4300 $52.6100
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 2.022222 $96.9400 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 44 51 62.032266 $310160.5000 $4999.9900
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 3 4.088889 $283.5700 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 801 998 978.963004 $48948.1800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 173 186 176.416243 $8820.7900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 72 75 72.419266 $1810.4900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2123 2771 5894.786987 $294739.8100 $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 1104 1434 2888.492946 $144424.8300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 118 139 236.518259 $11825.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 73 143 227.555555 $5688.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 542 720 1535.969340 $76798.5600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 86 106 197.590483 $9879.5500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 30 57 71.533336 $1788.3400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1517 1797 3079.403209 $153970.3200 $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 -T1027TTSC EI GROUP SESSION BY EI PROF 5 6 31.923810 $861.9400 $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 815 987 7755.426920 $418793.5000 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 38 50 314.336506 $16974.2000 $54.0000
INTR -T1013 INTERPRETER 317 461 1584.135708 $79206.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 3220 4415 35467.524559 $425610.8200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 101 131 972.346032 $79071.2700 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 2 2 6.400000 $520.4500 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 18 20 206.623808 $13455.3700 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 13 16 80.604763 $6554.7700 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 4 4 -2.147619 $-174.6400 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
PHY -97110 PT SESSION BY LICENSED PT 114 132 1174.607937 $95519.1500 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 2 3 18.000000 $1463.7600 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 1 1 10.285714 $836.4300 $81.3200
PHY -97110HM PT SESSION BY PT ASST 6 7 61.857143 $4028.1300 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 8 12 73.006349 $5936.8900 $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 1 2 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 1.755556 $806.2100 $459.2300
SENS -V5264 EARMOLD 9 10 12.412698 $225.0400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 170 192 1632.446024 $132750.6500 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 22.857142 $1858.7500 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 19.000000 $1237.2800 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 13 14 81.423808 $6621.3700 $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 1641 2479 18678.311226 $8311.8500 $0.4500
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Subtotal (Total Children Is Unduplicated) 6855 18275 85103.715873 $2426881.8000 $28.5200
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Total 19923 93518.380978 $2687501.4400 $28.7400
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Number of Children (Unduplicated) With at Least One Authorization 7475