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 52542 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 656 739 1373.330614 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 16.877778 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 151 157 10219.423810 $378118.7000 $37.0000
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Subtotal (Total Children Is Unduplicated) 806 903 11612.165535 $378212.4300 $32.5700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 297 379 320.433115 $15541.0400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 10 10 13.212557 $746.3800 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 0.761111 $15.0000 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 652 666 687.915079 $16159.1200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 11 12 10.338889 $143.4000 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 8 6.388889 $151.4200 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 21 25 20.738204 $188.3000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 23 27 24.188889 $673.1800 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 4 5.516667 $212.2300 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 10 5.693759 $483.0500 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 1.249315 $63.8000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 16 19 15.427778 $257.6400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 9 7.271538 $162.8800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 14 16 34.547185 $1554.6300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 13 8.103728 $931.9100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 33 38 33.070777 $1653.5500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 824 853 1345.066610 $67253.3300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 6 6.931507 $519.8600 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 21 22 22.045204 $1653.3900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 6.179452 $463.4600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 15 12.526029 $939.4400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 59 60 39.764386 $2206.9100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 2.002740 $111.1500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 98 101 82.254797 $6169.1000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 26 26 41.302153 $3097.6600 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 35 35 18.109593 $1358.2100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 151 151 158.651464 $8805.1600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 0.005479 $0.3100 $55.7000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 56 59 92.032879 $6902.4500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 0.002740 $0.2000 $73.9100
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 31.899999 $1595.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 15.242856 $762.1400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 14 14 11.372225 $580.5700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 3.505556 $178.9600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 19 20 16.678180 $851.4200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 136 146 119.623361 $6106.8200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 18 19 10.672225 $544.8300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.011111 $51.6200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 10 10 7.147945 $364.9000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 84 103 57.809671 $2951.2200 $51.0500
SCREEN-T1023 SCREENING 21 21 26.683333 $1334.1700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.021766 $15.3300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 4.166819 $212.7200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 3.505556 $178.9600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 160 180 113.704064 $5804.6400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 5 5 4.249315 $216.9300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 31 32 32.929648 $1467.0100 $44.5500
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Subtotal (Total Children Is Unduplicated) 2503 3158 3486.961622 $161935.7700 $46.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 109 132 151.884325 $759422.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 7 3.171843 $158.6000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 32 34 31.828386 $1591.4200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 5 3.238890 $231.9400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 32 33 32.283334 $7425.1800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1336 1684 1715.504055 $85775.5600 $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 175 191 168.953831 $4223.8600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4071 5255 9668.012964 $483399.8000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 17 17 7.512698 $375.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 524 671 914.708934 $22867.7300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2616 3534 5196.125663 $259805.7800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.919047 $45.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 216 424 530.267859 $13256.7000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1478 1929 3285.643090 $164281.8800 $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 4466 5572 7631.330417 $381565.5600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 12 12 2.822222 $141.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 515 634 801.347626 $20033.7000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 34 38 291.996033 $7299.9000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 7.276190 $363.8100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3248 4128 33979.973784 $1698998.7600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 101 102 226.988892 $11349.4500 $50.0000
INTR -T1013 INTERPRETER 279 360 1875.906405 $93795.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9091 15473 99342.564086 $993425.6200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 296 362 2678.837302 $191376.1300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 6 6 8.771429 $626.6400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 126 156 1004.264287 $57443.9200 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 4.285714 $245.1400 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 0.857143 $61.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 396 487 3257.850396 $232740.8700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 3 1.666667 $119.0700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 21 25 205.464286 $11744.3400 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 5.428571 $387.8200 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 2.810655 $182.7000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 1.021766 $116.4900 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 7 8 7.787442 $1775.5000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 7 5.168646 $2356.9300 $456.0000
SENS -V5264 EARMOLD 26 28 19.637442 $353.4700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 733 869 6502.238823 $464520.0300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 16 16 22.642856 $1617.6100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 8 98.285714 $5621.9400 $57.2000
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.142857 $81.6500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 34 36 339.240480 $4708.6500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 91 109 97.519048 $3608.2400 $37.0000
TRAV -TRAVS Travel by mile 2727 5979 530780.873184 $236197.4900 $0.4500
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Subtotal (Total Children Is Unduplicated) 15024 48481 711120.338616 $6231123.6800 $8.7600
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Total 52542 726219.465773 $6771271.8900 $9.3200
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Number of Children (Unduplicated) With at Least One Authorization 16230