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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 63057 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
CASE -CASE NON-TCM CASE MANAGEMENT 4 4 2.533333 $93.7300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 508 575 1116.031093 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 16.877778 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1102 1154 59308.606348 $2194418.4700 $37.0000
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Subtotal (Total Children Is Unduplicated) 1539 1736 60444.048552 $2194512.2100 $36.3100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 222 285 239.994454 $11639.7700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 24 24 26.706164 $1508.6300 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 743 770 824.139683 $19359.0400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 15 12.077778 $167.5200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 51 53 32.011116 $758.6700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 17 18 15.775505 $143.2400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 28 29 36.962198 $1028.6600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 3 5.000000 $192.3500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 37 42 48.150000 $4085.0500 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 8 9 5.924734 $302.5800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 39 41 40.288204 $672.8100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 8 7.755555 $173.7200 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 25 27 20.366135 $916.4800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 17 8.473669 $974.4800 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 28 31 25.693152 $1284.6700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 613 634 986.300705 $49315.0400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 3.500000 $262.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 51 52 84.027397 $6302.0500 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 12 12 19.510958 $1463.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 12 12 22.175342 $1663.1500 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 36 47 62.653960 $4699.0300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 75 84 101.649263 $5641.5000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 2.008220 $111.4500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 375 378 599.770177 $44982.6700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 163 163 288.949613 $21671.2400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 88 88 109.121922 $8184.1100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 493 497 740.173975 $41079.5800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 282 321 536.630596 $40247.2700 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 31.899999 $1595.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 9 13 48.566665 $2428.3300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 81 87 40.086625 $2046.4700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 10 10 14.093651 $719.4800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 96 106 71.156544 $3632.5300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 694 803 475.324224 $24265.5900 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.116667 $5.9600 $51.0600
PSTF -97164 PT RE-EVAL EST PLAN CARE 49 53 16.043766 $819.0700 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.1000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 4.550000 $232.2800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 54 56 67.810578 $3461.7300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 487 589 355.157873 $18131.0500 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 91 97 94.730158 $4736.5100 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 1.011111 $15.1700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 24 26 36.995890 $1888.6400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 28 29 24.717048 $1261.8100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 803 918 565.434507 $28865.7000 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.183333 $9.3600 $51.0400
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 18 18 14.463775 $738.3800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 120 130 136.973540 $6102.1800 $44.5500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.088889 $3.2000 $35.9800
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Subtotal (Total Children Is Unduplicated) 4240 6626 6918.195318 $370614.1200 $53.5700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 232 278 280.827098 $1404137.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 14 11.566287 $578.3200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 39 47 45.663239 $2283.1500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 4.666667 $334.1800 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 11 11 18.542064 $1327.8000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 36 37 43.055556 $9902.7900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1071 1373 1439.711704 $71985.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 192 216 188.647042 $4716.1800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2951 3823 6982.551961 $349126.9400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 11 11 3.923809 $196.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 410 531 745.605559 $18640.1400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1763 2416 3598.045144 $179901.9300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.919047 $45.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 162 321 415.134526 $10378.3700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1102 1415 2378.370991 $118918.3400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 5 5 1.733333 $86.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 88 168.288892 $4207.2300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3011 3737 4963.401901 $248169.4200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 6 6 1.277777 $63.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 401 505 663.601594 $16590.0500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 377 514 5713.660311 $142841.5100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 7.276190 $363.8100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11097 14595 116985.790405 $5849289.9400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 263 266 626.028567 $31301.4700 $50.0000
INTR -T1013 INTERPRETER 248 322 1670.153307 $83507.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6585 11195 71108.466513 $711084.6700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1417 1816 12733.142861 $909655.7700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 46 46 97.371429 $6956.2300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 660 820 5686.415881 $325262.9800 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 13 13 38.000000 $2173.6000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.571429 $40.8200 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 5.285714 $377.6100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1626 2116 13995.376973 $999829.8400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 30 30 58.976191 $4213.2700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 207 265 1958.002094 $111919.4300 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 5 3.657143 $209.0500 $57.1600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 1.714286 $97.9900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 2.000000 $130.0000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 5 8 2.764535 $630.2800 $227.9900
SENS -V5060 BEHIND EAR HEARING AID 3 3 3.000000 $684.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 8 6.500001 $2964.0500 $456.0100
SENS -V5264 EARMOLD 51 62 59.497183 $1070.9500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2262 2833 20738.069437 $1481527.7900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 68 69 116.016666 $8288.2600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 49 56 361.317462 $20667.3600 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 4 4 24.285714 $1734.9700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 9.000000 $642.9600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 216 247 1745.769053 $24231.2700 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.357143 $4.9600 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 59 72 56.304761 $2083.3000 $37.0000
TRAV -TRAVS Travel by mile 2045 4480 414546.101636 $184473.0200 $0.4500
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Subtotal (Total Children Is Unduplicated) 14306 54695 690316.407076 $13349849.1600 $19.3400
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Total 63057 757678.650946 $15914975.4900 $21.0000
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Number of Children (Unduplicated) With at Least One Authorization 14894