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 47008 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 644 712 1420.939937 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 15.571429 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 178 181 5630.657145 $208334.3200 $37.0000
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Subtotal (Total Children Is Unduplicated) 823 899 7073.724067 $208576.8700 $29.4900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 279 369 347.249060 $16841.6000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 11 17.249315 $974.4100 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 3 1.011112 $19.9300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 622 653 680.849208 $15993.1500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 11 13 11.300001 $156.7300 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 6 3.016667 $71.5000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 15 18 12.560427 $114.0500 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 17 18 14.577779 $405.7000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 3 0.894445 $34.4100 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 11 7.338205 $622.5800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 3 1.249315 $63.8000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 11 12 7.500001 $125.2500 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 12 7.299316 $163.5100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 14 19 16.888422 $759.9800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 10 3.795053 $436.4500 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 26 27 19.459668 $973.0000 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 694 706 1127.605035 $56380.2400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 10 10 16.123288 $1209.2400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 17.538812 $1315.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 3.008296 $225.6200 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 0.005556 $0.4200 $75.5900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 13.837378 $1037.8100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 2.009589 $150.7200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 7 4.542466 $340.6800 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 0.010959 $0.8300 $75.2800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 43 43 71.013700 $3941.2500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 22 22 14.613698 $811.0500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 25.498630 $1912.4000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 34 37 36.586301 $2743.9800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 9.500000 $712.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 10 10 18.504110 $1387.8100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 4.500000 $337.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 16 16 11.542466 $865.6900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 65 66 107.241096 $5951.8900 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 34 36 33.093149 $1836.6800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 32 42 79.593150 $5969.4900 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 3.000000 $225.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 9.571428 $478.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 1.466667 $73.3400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 12 14 3.983336 $203.3600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 1.400000 $71.4700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 18 6.973974 $356.0200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 113 122 85.845668 $4382.4500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 15 21 10.350003 $528.3800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.244444 $12.4800 $51.0400
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 8 3.512482 $179.3200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 79 90 62.283287 $3179.6000 $51.0500
SCREEN-T1023 SCREENING 18 19 21.181745 $1059.0900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 0.249315 $3.7400 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 2.755556 $140.6700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 5.172222 $264.0400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 122 135 66.560590 $3397.9600 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 3.000000 $153.1500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 5 5 4.123288 $210.4900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 29 29 48.177778 $2146.3200 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.944444 $47.2200 $50.0000
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Subtotal (Total Children Is Unduplicated) 2167 2723 3097.401900 $142399.9000 $45.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 82 97 102.166590 $510832.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 3.266667 $163.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 26 33 32.877094 $1643.8600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 4 1.755556 $125.7200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 25 26 31.100000 $7153.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 992 1294 1440.798509 $72040.0400 $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 438 488 375.098133 $9377.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3684 4787 8970.532873 $448525.9200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 73 87 116.090476 $5804.5200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 460 574 811.506349 $20287.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2504 3359 5081.451122 $254072.2300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 62 67 76.333328 $3816.6400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 197 349 454.262306 $11356.5700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1468 1861 3198.402800 $159919.8600 $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 4244 5246 7230.520566 $361525.3200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 92 99 106.914282 $5345.7000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 442 537 678.565081 $16964.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 23 27 107.021428 $2675.5400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 37.703175 $1885.1600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2893 3582 29183.637269 $1459181.8500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 237 266 2189.139675 $109457.0200 $50.0000
INTR -T1013 INTERPRETER 174 215 1475.107144 $73755.3500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8173 13409 87079.507828 $870795.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 271 339 2543.216662 $181687.3400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 9 11 57.519843 $4109.2000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 115 137 1067.995239 $61089.3400 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 3 3 32.285714 $1846.7400 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 4 5 40.695239 $2907.2700 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 10.142857 $724.6100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 341 421 2828.390873 $202060.3000 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 5 17.766667 $1269.2500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 24 26 226.500000 $12946.7500 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 6.357143 $454.1500 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 4 4 13.160318 $940.1700 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 3 1.249315 $81.2000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 2 0.249315 $28.4200 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 7 8 7.713775 $1758.7700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 8 12.100001 $5517.6500 $456.0000
SENS -V5264 EARMOLD 21 24 24.013777 $432.2500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 630 752 5801.244036 $414440.9000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 35 39 263.068254 $18793.5900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 8 63.714288 $3644.4500 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.857143 $132.6700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 7 7 57.000001 $4072.0700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 26 30 267.035713 $3706.4600 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 156 189 1218.537697 $45085.9200 $37.0000
TRAV -TRAVS Travel by mile 2340 4700 433375.346581 $192852.0300 $0.4500
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Subtotal (Total Children Is Unduplicated) 13694 43386 596974.033741 $5576499.7400 $9.3400
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Total 47008 607145.159708 $5927476.5200 $9.7600
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Number of Children (Unduplicated) With at Least One Authorization 14881