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
Eligibility Filter: Program Patients
With the filters selected there were 90867 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 684 771 1456.695369 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 4 20.020635 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1451 1515 81798.050800 $3026527.9200 $37.0000
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Subtotal (Total Children Is Unduplicated) 2052 2294 83277.300137 $3026621.6500 $36.3400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 336 432 358.044532 $17365.2100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 63 66 84.083562 $4749.8900 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 6 6 3.761111 $74.1300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1068 1103 1169.281747 $27466.4300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 42 48 40.204871 $557.6400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 96 101 74.933342 $1775.9400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 58 68 57.324135 $520.5000 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 1.366667 $13.6100 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 77 87 86.065395 $2395.2000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 7 8 9.516667 $366.1100 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 68 78 72.771537 $6173.9300 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 17 19 14.562938 $743.7400 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 75 83 74.338205 $1241.4500 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 29 33 29.437519 $659.4000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 58 66 72.089957 $3244.0600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 37 48 33.080668 $3804.2500 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 38 44 43.248555 $2162.4400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 865 896 1421.488832 $71074.4400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 7 8.431507 $632.3600 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 75 76 113.561643 $8517.1100 $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 14 14 23.510958 $1763.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 15 15 26.179452 $1963.4600 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 54 71 93.996426 $7049.7100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 131 143 150.321868 $8342.8200 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 6 4.010960 $222.6000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 570 576 865.540040 $64915.4000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 238 238 425.257245 $31894.3100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 138 139 155.241102 $11643.0400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 704 710 1028.568690 $57085.4800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 4.005479 $222.3100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 399 453 751.800657 $56385.0100 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 4.002740 $300.2000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 10 46.899999 $2345.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 16 22 74.049205 $3702.4500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 118 128 56.568549 $2887.8900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 18 18 21.104763 $1077.4000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 150 163 114.934418 $5867.4000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 1050 1208 760.463698 $38822.0500 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.116667 $5.9600 $51.0600
PSTF -97164 PT RE-EVAL EST PLAN CARE 90 99 33.660437 $1718.4200 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 2.000000 $102.1000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 10 10 8.000000 $408.4000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 81 85 89.749109 $4581.6900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 685 834 496.354202 $25339.2100 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 141 148 152.424602 $7621.2300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 8 11 25.859861 $387.9000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 38 40 48.523820 $2477.1400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 44 45 50.489271 $2577.4800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1271 1456 926.114361 $47278.5000 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.183333 $9.3600 $51.0400
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.466667 $23.8300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 34 34 29.835312 $1523.0900 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.027778 $1.4200 $51.0900
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 199 212 210.300756 $9368.9100 $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) 6381 10175 10453.244704 $553806.5600 $52.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 369 452 455.612414 $2278064.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 26 34 34.055175 $1702.7600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 92 107 128.410431 $6420.5000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 4.666667 $334.1800 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 21 22 35.514287 $2543.1900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 102 109 115.237923 $26504.7400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1502 1886 1963.717956 $98186.2600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 2 2 0.900000 $45.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 291 330 291.039573 $7275.9900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4114 5311 9731.924672 $486595.3700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 17 17 7.512698 $375.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 525 673 916.408934 $22910.2300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2635 3555 5223.374674 $261168.2300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.919047 $45.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 216 425 530.967859 $13274.2000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1519 1977 3331.672456 $166583.3500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 9 9 2.800001 $140.0100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 55 119 199.583333 $4989.5800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4505 5620 7681.246290 $384061.3500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 12 12 2.822222 $141.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 519 638 802.842071 $20071.0600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 490 652 8108.649994 $202716.2600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 7.276190 $363.8100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15140 19925 159880.178872 $7994009.2900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 380 384 874.887298 $43744.4100 $50.0000
INTR -T1013 INTERPRETER 288 371 1941.834976 $97091.7600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9094 15480 99405.992657 $994059.9100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2278 2948 20527.208200 $1466463.7800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 72 74 168.071430 $12007.0400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 907 1127 7739.993262 $442727.6300 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 24 24 59.142857 $3382.9700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 0.571429 $40.8200 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 6.142857 $438.8400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2526 3311 22159.921052 $1583104.9300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 61 62 106.352380 $7597.8500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 260 333 2427.459237 $138753.5900 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 5 3.657143 $209.0500 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 5.428571 $387.8200 $71.4400
PHY -97110TLHM PT SESSION BY PT ASST 1 1 1.714286 $97.9900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 8 5.685236 $369.5400 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 4 5 2.424810 $276.4300 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 18 24 14.976634 $3414.6000 $227.9900
SENS -V5060 BEHIND EAR HEARING AID 8 10 11.044444 $2518.1200 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 28 32 37.438358 $17071.9600 $456.0000
SENS -V5264 EARMOLD 116 142 149.350595 $2688.3000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4312 5504 40306.778637 $2879516.4400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 137 143 237.576189 $16972.5100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 60 69 447.998414 $25625.5100 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 7 7 55.285714 $3949.6100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 11 11 13.642856 $974.6600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 302 340 2497.538102 $34665.8100 $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 92 111 98.233333 $3634.6700 $37.0000
TRAV -TRAVS Travel by mile 2729 5985 531602.587470 $236563.1500 $0.4500
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Subtotal (Total Children Is Unduplicated) 20571 78398 930366.629309 $19996877.1800 $21.4900
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Total 90867 1024097.174150 $23577305.3900 $23.0200
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Number of Children (Unduplicated) With at Least One Authorization 21374