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
Eligibility Filter: Program Patients
With the filters selected there were 35002 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 814 909 5116.051567 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 10.355555 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 47 51 10841.242857 $495227.9800 $45.6800
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 863 962 15967.649979 $495227.9800 $31.0100
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 5 6 5.544444 $647.7500 $116.8300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 209 249 202.795903 $9835.6100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 28 30 23.218264 $1432.7900 $61.7100
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 14 14 18.338889 $278.5700 $15.1900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 83 93 88.831743 $1906.3200 $21.4600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 0.500000 $13.0200 $26.0400
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 63 65 76.183953 $1230.3700 $16.1500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 30 32 28.016665 $680.2400 $24.2800
AUDE -92558 OTOACOUSTIC EMISSIONS (SCREENING) 1 1 1.000000 $6.8700 $6.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 59 61 73.142857 $579.2900 $7.9200
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.8800 $10.8800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 65 67 91.065383 $2896.7900 $31.8100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 5 2.533333 $125.6300 $49.5900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 29 31 17.744443 $269.5400 $15.1900
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 70 73 86.853175 $2009.7800 $23.1400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 2 2 -0.844444 $-46.3600 $54.9000
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.488889 $38.2600 $78.2500
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 2 3 2.155555 $175.1100 $81.2400
AUDE -V5010 ASSESSMENT FOR HEARING AID 21 22 25.454783 $1153.6200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 11 13 10.422222 $1207.0000 $115.8100
EXIT -EXIT COS Exit 384 395 369.382888 $18469.1400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 14 26.011111 $2106.3800 $80.9800
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 8.180974 $662.5000 $80.9800
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 6.000000 $485.8800 $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 2 2 3.000000 $242.9400 $80.9800
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 1.000000 $80.9800 $80.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 18 35.862699 $2148.8900 $59.9200
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 8 8 12.011111 $719.7100 $59.9200
IPDEF -T1024TSTL F/U PSYCH AND DEV EVAL BY EI PROF 4 6 12.000000 $971.7600 $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 106 109 212.510958 $17209.1400 $80.9800
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 21 22 43.500000 $3522.6300 $80.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 32 33 66.000000 $5344.6800 $80.9800
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 13 13 26.000000 $2105.4800 $80.9800
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 45 45 88.000000 $7126.2400 $80.9800
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 7 8 15.500000 $1255.1900 $80.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 91 94 185.796672 $11132.9400 $59.9200
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 69 70 139.500000 $8358.8400 $59.9200
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 40 48 97.000000 $7855.0600 $80.9800
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 22 32 63.500000 $5142.2300 $80.9800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 28 36 103.439684 $5171.9900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 18.285714 $914.2900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 43 47 24.293758 $1411.7000 $58.1100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 10.428571 $606.0100 $58.1100
OCTH -97165 OT EVAL LOW COMPLEXITY 45 47 49.500468 $2876.4800 $58.1100
OCTH -97165GT OT EVAL LOW COMPLEXITY 6 6 4.861111 $282.4800 $58.1100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 15 16 14.487770 $841.8900 $58.1100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $58.1100 $58.1100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.005556 $0.3300 $58.5700
OCTH -97167 OT EVAL HIGH COMPLEXITY 43 55 38.216667 $2220.7700 $58.1100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 12 12 5.772221 $335.4200 $58.1100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.511111 $29.7000 $58.1100
PSTF -97164 PT RE-EVAL EST PLAN CARE 33 35 15.487289 $899.9600 $58.1100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 3 2.177778 $126.5500 $58.1100
PSTH -97161 PT EVAL LOW COMPLEXITY 40 44 36.488889 $2120.3700 $58.1100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 2.000000 $116.2200 $58.1100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 10 5.472679 $318.0200 $58.1100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 2 0.511111 $29.7000 $58.1100
PSTH -97163 PT EVAL HIGH COMPLEXITY 37 47 27.622222 $1605.1300 $58.1100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 0.544444 $31.6400 $58.1100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 11 13 4.094444 $237.9300 $58.1100
SCREEN-T1023 SCREENING 8 8 8.000000 $431.8400 $53.9800
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.611111 $9.2300 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 80 87 97.857902 $5686.5200 $58.1100
SPCH -92521GT EVAL OF SPEECH FLUENCY 6 6 2.733334 $158.8400 $58.1100
SPCH -92521TL EVAL OF SPEECH FLUENCY 4 5 1.850000 $107.5000 $58.1100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 12.000000 $697.3200 $58.1100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.022222 $59.4000 $58.1100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 2 2.000000 $116.2200 $58.1100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 138 157 108.702487 $6316.7000 $58.1100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $58.1100 $58.1100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.422222 $82.6400 $58.1100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 13 15 10.005556 $581.4300 $58.1100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.427778 $24.8600 $58.1100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 30 36 342.780950 $19919.0200 $58.1100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 4 24.000000 $1394.6400 $58.1100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1524 2414 3153.817519 $175964.6000 $55.7900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 4 4 4.044444 $193.8900 $47.9400
ASST -ASST ASSISTIVE TECHNOLOGY 128 147 214.802954 $1074015.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 8 10 14.200001 $984.7800 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.372222 $95.1600 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 9.663166 $2238.1900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1226 1530 1560.295414 $78014.8000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 279 317 299.927997 $14996.3500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 102 108 127.206133 $3180.1600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3247 4227 9006.298137 $450315.5100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 267 333 677.066683 $33853.3800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 281 329 437.002373 $10925.0400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1687 2203 4507.213596 $225360.9300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 177 205 345.300802 $17265.0900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 99 186 275.480951 $6887.0200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 930 1247 2658.140780 $132907.1700 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 154 195 345.528215 $17276.4500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 46 82 100.395242 $2509.8900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2402 2853 5124.672284 $256233.8900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 234 273 452.545674 $22627.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 299 349 541.470691 $13536.7800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 25 27 149.223810 $4029.0500 $27.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 7 11 45.928571 $2296.4400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3825 4743 39133.429842 $2113207.6900 $54.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 164 200 1381.012692 $74574.7900 $54.0000
INTR -T1013 INTERPRETER 351 506 1747.197612 $87359.9100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4413 6251 49132.258557 $589587.8200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 327 406 2591.883328 $210772.2500 $81.3200
OCCT -97530GO OT SESSION BY LICENSED OT 11 11 54.607141 $4440.6600 $81.3200
OCCT -97530GOGT OT SESSION BY LICENSED OT 6 6 39.500001 $3212.1400 $81.3200
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 5.857143 $476.3100 $81.3200
OCCT -97530HM OT SESSION BY OT ASST 55 62 556.680950 $36251.1100 $65.1200
OCCT -97530TL OT SESSION BY LICENSED OT 25 30 131.869841 $10723.6500 $81.3200
OCCT -97530TLGO OT SESSION BY LICENSED OT 5 5 10.138095 $824.4300 $81.3200
OCCT -97530TLGOGT OT SESSION BY LICENSED OT 1 1 0.388889 $31.6300 $81.3200
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.071429 $5.8100 $81.2900
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 12.142857 $790.7500 $65.1200
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 1.000000 $65.1200 $65.1200
PHY -97110 PT SESSION BY LICENSED PT 318 389 2969.321426 $241465.4400 $81.3200
PHY -97110GP PT SESSION BY LICENSED PT 4 6 34.357143 $2793.9300 $81.3200
PHY -97110GPGT PT SESSION BY LICENSED PT 6 8 49.671428 $4039.2800 $81.3200
PHY -97110GT PT SESSION BY LICENSED PT 4 4 -7.480953 $-608.3500 $81.3200
PHY -97110HM PT SESSION BY PT ASST 21 24 204.990476 $13348.9700 $65.1200
PHY -97110HMGT PT SESSION BY PT ASST 2 2 19.571428 $1274.4900 $65.1200
PHY -97110TL PT SESSION BY LICENSED PT 15 20 143.292063 $11652.5300 $81.3200
PHY -97110TLGP PT SESSION BY LICENSED PT 1 1 7.571429 $615.7100 $81.3200
RSPT -RSPT RESPITE 1 1 13.142857 $0.0000 $0.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 4.133333 $949.0500 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 8 10 9.680974 $2222.8500 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 3 1.755556 $806.2100 $459.2300
SENS -V5261 BEHIND EAR DIGITAL BINAURAL HEARING 1 1 0.252055 $247.2400 $980.9200
SENS -V5264 EARMOLD 24 29 54.922723 $995.7500 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 551 658 4711.686480 $383154.6900 $81.3200
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 24 27 174.490475 $14189.5900 $81.3200
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 8 46.571428 $3032.7200 $65.1200
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 13.142857 $855.8700 $65.1200
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 24 27 145.242855 $11811.1300 $81.3200
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 6 5.142857 $418.2200 $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 2235 3521 26645.445294 $11857.2300 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 11541 31626 156968.360796 $6208958.4200 $39.5600
-------------------------------------------------------------------------------------------------------------------------------------
Total 35002 176089.828294 $6880151.0000 $39.0700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 12485