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
Eligibility Filter: Program Patients
With the filters selected there were 82010 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 670 740 1481.225651 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 15.571429 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1013 1044 41412.644463 $1532267.8700 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1641 1790 42915.997099 $1532510.4300 $35.7100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 318 424 387.349593 $18786.4600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 65 67 96.431964 $5447.4400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 6 7 5.011112 $98.7700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 953 1000 1069.750002 $25128.4300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 38 43 37.593761 $521.4300 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 95 102 69.750005 $1653.0900 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 53 60 70.179453 $637.2300 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $9.9600 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 63 70 81.838892 $2277.5900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 6 3.894445 $149.8200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 67 72 67.871537 $5758.2200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 18 19 16.559741 $845.7000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 65 66 60.440565 $1009.3600 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 36 41 39.743076 $890.2500 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 53 66 49.395802 $2222.8000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 36 42 25.252965 $2904.0800 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 29 30 22.476106 $1123.8200 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 725 738 1181.249479 $59062.4600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 14 14 22.123288 $1659.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 26 26 44.544291 $3340.8200 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 17 17 25.019407 $1876.4600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 10.500000 $787.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 2.005556 $150.4200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 13 20.837378 $1562.8100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 14 14 19.024810 $1426.8600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 21 24 26.056166 $1954.1900 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 1.010959 $75.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 94 96 164.182649 $9112.1300 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 35 35 38.624809 $2143.6700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 105 105 196.501370 $14737.6000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 266 273 481.639724 $36122.9900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 50 51 88.524656 $6639.3500 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 44 44 84.509589 $6338.2200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 16 16 28.502740 $2137.7000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 134 137 211.620552 $15871.5300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 366 369 653.754749 $36283.3900 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 143 145 239.620546 $13298.9500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 326 422 765.710913 $57428.3400 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 7.000000 $525.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 5 23.571428 $1178.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 16 19 57.951587 $2897.5800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 117 141 65.525082 $3345.1100 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.150685 $7.6900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 11 12 9.200000 $469.6600 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 122 133 100.236474 $5117.1000 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
OCTH -97167 OT EVAL HIGH COMPLEXITY 892 1042 639.948908 $32669.7500 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 0.706925 $36.0800 $51.0400
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 1.194444 $60.9700 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 3 3 1.538889 $78.5600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 69 84 109.354882 $5582.6200 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 3 4.005556 $204.4900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 8 6.305555 $321.9000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 75 78 60.856768 $3106.7600 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.372222 $19.0000 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 598 718 428.856702 $21893.4100 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 6 6 3.557154 $181.5900 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 3 0.475037 $24.2500 $51.0500
SCREEN-T1023 SCREENING 165 174 167.415078 $8370.7500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 8 19.952815 $299.2900 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 34 35 35.658840 $1820.3900 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 42 45 38.880898 $1984.8700 $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 1094 1253 756.082479 $38598.4100 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 21 21 15.183867 $775.1400 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.505556 $76.8600 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 5.261111 $268.5800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 32 35 32.817048 $1675.3100 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.505556 $25.8100 $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 232 250 269.448493 $12003.9500 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.944444 $47.2200 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5583 8779 9288.128244 $485812.4600 $52.3000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 318 411 366.236901 $1831184.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 20 26 31.838888 $1591.9400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 76 94 117.523516 $5876.1800 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 11.111111 $795.6700 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 17 20 51.216668 $3667.6400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 90 103 136.720853 $31445.8100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1072 1399 1593.035518 $79651.8800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 57 64 56.888847 $2844.4500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 624 751 644.726685 $16118.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3734 4848 9047.343300 $452366.4500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 73 87 116.090476 $5804.5200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 464 578 820.045237 $20501.1400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2524 3386 5116.840118 $255841.6800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 62 67 76.333328 $3816.6400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 197 350 454.712306 $11367.8200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1503 1901 3242.291690 $162114.3100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 47 51 58.544443 $2927.2200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 62 128 137.681749 $3442.0500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4282 5289 7289.740408 $364486.3100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 92 99 106.914282 $5345.7000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 450 546 687.920636 $17198.0300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 357 588 5170.334127 $129258.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 37.703175 $1885.1600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 12.000000 $600.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13618 17563 139125.983603 $6956299.4100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 783 860 6853.344445 $342667.3000 $50.0000
INTR -T1013 INTERPRETER 181 225 1508.115080 $75405.7400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8173 13412 87100.507828 $871005.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2095 2712 18441.275893 $1317444.8300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 130 147 1021.268250 $72959.4000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 789 1028 7220.106340 $412990.1700 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 33 33 299.321430 $17121.1800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 14 15 132.052383 $9433.8200 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 35 36 221.742855 $15841.3100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2407 3097 20967.608216 $1497926.1600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 115 124 906.925398 $64790.7900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 199 260 1834.815984 $104878.1000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 11 11 85.038096 $4860.7800 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 11 12 56.195236 $4014.5900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 35 40 205.788094 $14701.5100 $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 6 8 5.520852 $358.8600 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 4 5 2.485084 $283.3000 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 19 22 16.461871 $3753.3100 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 6 6 7.444444 $1697.3200 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 24 28 52.987824 $24162.4800 $456.0000
SENS -V5264 EARMOLD 104 125 177.509968 $3195.1800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4122 5186 38051.214066 $2718379.0000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 286 318 2305.865075 $164731.0200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 42 61 350.642861 $20056.7600 $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 20 20 161.571429 $11542.6700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 73 77 454.110318 $32441.6500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 241 314 2000.739423 $27770.2900 $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 156 190 1225.823411 $45355.4900 $37.0000
TRAV -TRAVS Travel by mile 2340 4704 434173.203724 $193207.0700 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 19016 71441 800372.535171 $18440560.8600 $23.0400
-------------------------------------------------------------------------------------------------------------------------------------
Total 82010 852576.660514 $20458883.7500 $24.0000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 19910