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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 56342 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 6.555556 $242.5600 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 512 570 1132.251842 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 15.571429 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 733 758 28310.295249 $1047480.9300 $37.0000
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Subtotal (Total Children Is Unduplicated) 1208 1334 29464.674076 $1047723.4800 $35.5600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 212 279 266.873258 $12943.3400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 31 33 39.633334 $2238.8900 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 2.000000 $39.4200 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 654 686 753.916667 $17709.5000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 11 13 12.205555 $169.2900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 49 55 30.661114 $726.6700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 18 21 39.497488 $358.6400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 21 24 44.024885 $1225.2100 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $38.4700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 39 41 46.133332 $3913.9400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 7 7 5.288204 $270.0700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 33 33 34.151674 $570.3300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 11 13 17.355555 $388.7600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 20 23 15.170470 $682.6600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 15 7.330136 $842.9600 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 24 25 15.087217 $754.3700 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 488 495 756.175660 $37808.7700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 8.000000 $600.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 16 26.505479 $1987.9100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 13 13 22.011111 $1650.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 9.000000 $675.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 10 10 15.015221 $1126.1400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 10 10 8.013700 $601.0100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 58 60 107.586757 $5971.0600 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 18 18 27.024809 $1499.8800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 76 76 142.502740 $10687.7000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 184 187 354.043834 $26553.2900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 35 36 58.024656 $4351.8500 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 26 26 50.005479 $3750.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 10 10 18.002740 $1350.2000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 96 97 156.075346 $11705.6400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 249 251 436.516392 $24226.6600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 97 97 187.513698 $10407.0100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 231 306 550.909543 $41318.2300 $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 3 3 9.571428 $478.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 13 36.523810 $1826.1900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 76 93 44.542179 $2273.9200 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.150685 $7.6900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 6 6 4.677778 $238.8000 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 89 94 76.449562 $3902.7800 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
OCTH -97167 OT EVAL HIGH COMPLEXITY 594 690 401.606554 $20502.2700 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.194444 $9.9200 $51.0400
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 0.538889 $27.5100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 46 53 94.554877 $4827.0600 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 3 4.005556 $204.4900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 3.061111 $156.2700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 47 49 42.772747 $2183.5600 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.372222 $19.0000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 412 498 295.689275 $15095.1200 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 4 4 2.362710 $120.6200 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 3 0.475037 $24.2500 $51.0500
SCREEN-T1023 SCREENING 99 105 96.288888 $4814.4400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.011111 $15.1700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 24 24 27.653969 $1411.7400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 27 27 24.275341 $1239.2500 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 684 784 461.857743 $23578.0900 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 14 14 9.450533 $482.4500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 4.261111 $217.5300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 15 17 14.693760 $750.1200 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.188889 $9.6400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 143 150 160.893622 $7167.8300 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.944444 $47.2200 $50.0000
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Subtotal (Total Children Is Unduplicated) 3672 5657 6107.696551 $322415.2300 $52.7900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 196 252 225.309145 $1126545.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 10 11.344444 $567.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 33 42 43.022223 $2151.1200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 10.111111 $724.0600 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 11 12 24.744445 $1771.9500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 36 41 61.127778 $14059.3900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 766 995 1126.618141 $56331.0100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 32 33 21.323484 $1066.1900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 435 516 439.805211 $10995.1800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2672 3461 6287.178174 $314358.3900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 43 53 66.240477 $3312.0300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 366 457 694.724603 $17368.1300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1695 2265 3461.368998 $173068.2200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 38 41 54.216663 $2710.8200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 142 257 348.363893 $8709.1100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1104 1406 2354.689248 $117734.2700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 29 32 31.083332 $1554.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 50 106 113.959525 $2848.9900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2819 3476 4590.349105 $229516.9700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 61 68 69.986507 $3499.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 350 426 565.859525 $14146.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 270 443 3681.555555 $92038.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 37.703175 $1885.1600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9921 12796 101419.034036 $5070951.9600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 534 580 4604.673021 $230233.7000 $50.0000
INTR -T1013 INTERPRETER 159 200 1326.296032 $66314.7900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5897 9641 62217.450706 $622174.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1301 1680 11432.599199 $816744.9900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 80 91 672.291268 $48028.4800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 571 748 5141.423005 $294089.4600 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 19 19 151.421430 $8661.3000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 7 7 72.214287 $5158.9800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 24 25 129.742857 $9268.8300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1547 1990 13348.976474 $953651.0700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 59 62 439.595239 $31404.7000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 155 204 1381.513601 $78967.3200 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 9 9 81.352382 $4650.1000 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 9 10 47.695236 $3407.3500 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 23 26 123.484919 $8821.7700 $71.4400
PHY -97110TLHM PT SESSION BY PT ASST 1 1 13.000000 $743.0800 $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 7 2.528919 $576.5900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 8 15.633334 $7128.8300 $456.0000
SENS -V5264 EARMOLD 44 53 59.245737 $1066.4200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2189 2723 19623.277360 $1401887.0800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 126 136 1043.303962 $74533.6600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 33 48 269.714289 $15427.6500 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.285714 $359.5400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 13 13 109.071429 $7792.0600 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 46 49 264.681745 $18908.8800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 178 238 1455.767997 $20206.0800 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 3.785714 $52.5500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 108 131 787.328173 $29131.1600 $37.0000
TRAV -TRAVS Travel by mile 1732 3447 331098.382294 $147338.7800 $0.4500
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Subtotal (Total Children Is Unduplicated) 13155 49351 581666.455121 $12175229.7200 $20.9300
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Total 56342 617238.825748 $13545368.4400 $21.9500
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Number of Children (Unduplicated) With at Least One Authorization 13818