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: 07-01-19 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 145452 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 7 7 15.144445 $560.3500 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 1154 1444 4734.973666 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 9 10 79.574603 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2057 2678 247268.364338 $9148929.6200 $37.0000
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Subtotal (Total Children Is Unduplicated) 3055 4139 252098.057052 $9149489.9700 $36.2900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 383 615 637.525721 $30919.9900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 50 54 83.699652 $4728.2000 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 7 23.820352 $469.5000 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1424 1567 1788.057598 $42001.4700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 46 51 56.412026 $782.4400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 115 128 137.100793 $3249.2800 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 41 51 75.966907 $689.7800 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.961111 $9.5700 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 64 75 131.889129 $3670.4700 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 6 9.000000 $346.2300 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 78 91 118.605555 $10062.4900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 29 30 26.138281 $1334.8900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 83 92 91.263319 $1524.1000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 25 31 45.809133 $1026.1300 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 47 56 44.316210 $1994.2300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 30 45 40.401142 $4646.1600 $115.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 1 1 11.285714 $687.9800 $60.9600
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 16.428571 $801.0600 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 108 131 109.421914 $5471.1100 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1824 1884 3183.532787 $159176.6400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 16 18 23.798630 $1784.9000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 143 144 221.730595 $16629.7600 $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 48 48 70.525872 $5289.4400 $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 32 32 42.202741 $3165.1900 $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 134 177 235.878393 $17690.8200 $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 233 252 316.927969 $17589.4200 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 21 22 27.035769 $1500.4800 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.500000 $83.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1411 1418 2366.177036 $177463.0000 $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 665 668 1204.150971 $90311.3600 $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 385 386 410.160303 $30761.8100 $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 2045 2078 3253.291534 $180557.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 99 99 191.513698 $10629.0100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1332 1558 2577.202623 $193290.1700 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 8.000000 $600.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 10 79.438093 $3971.9000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 12 23 133.276190 $6663.8100 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 187 258 152.974364 $7809.4000 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.150685 $7.6900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 23 25 37.206436 $1899.3900 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.344444 $17.5800 $51.0400
OCTH -97166 OT EVAL MODERATE COMPLEXITY 200 233 201.410989 $10282.0700 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.027778 $1.4200 $51.0900
OCTH -97167 OT EVAL HIGH COMPLEXITY 1274 1717 1477.254877 $75413.8800 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.194444 $9.9200 $51.0400
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 0.655556 $33.4700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 122 169 147.119341 $7510.5000 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 3 4.005556 $204.4900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 17 19 16.550000 $844.8800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 105 120 162.313818 $8286.1100 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.372222 $19.0000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 819 1288 1105.946578 $56458.6700 $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 213 239 277.987297 $13899.3500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 2.877778 $43.1700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 43 48 88.929136 $4539.8300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 56 59 55.911721 $2854.2900 $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 1454 1923 1647.842502 $84122.4600 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 14 14 9.844825 $502.5800 $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 34 37 36.224201 $1849.2500 $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 254 285 428.817702 $19103.8300 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.955556 $34.3800 $35.9800
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 2 2 1.866667 $141.3500 $75.7200
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.816666 $90.8300 $50.0000
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Subtotal (Total Children Is Unduplicated) 9730 18665 24271.486209 $1373432.2200 $56.5900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 391 606 660.626251 $3303134.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 22 28 48.706469 $2435.3200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 63 103 211.248810 $10562.4700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 15.738889 $1127.0600 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 25 28 73.110633 $5235.4500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 129 139 185.140195 $42582.2900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2782 3986 4984.420078 $249221.5500 $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 766 930 820.236202 $20505.9700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5089 8461 28251.204674 $1412559.8500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 43 53 74.108731 $3705.4400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 676 1084 2947.834916 $73695.8600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2967 5130 13976.726811 $698836.3300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 38 41 55.135710 $2756.7700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 265 631 1684.607933 $42115.1900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1950 3177 9313.867088 $465693.3100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 29 32 32.516665 $1625.8300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 99 230 692.897620 $17322.4400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5093 7962 19687.772577 $984388.2500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 61 68 74.486506 $3724.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 665 1011 2549.201582 $63730.0300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 16 16 95.657141 $7013.5800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 676 1504 30241.243639 $756031.0600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 10 10 94.693651 $4734.6900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 17844 31539 460767.695382 $23038386.6700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 540 589 5175.663483 $258783.1800 $50.0000
INTR -T1013 INTERPRETER 626 931 6460.929129 $323046.4700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 10620 24714 285269.031876 $2852690.5100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2409 4000 48790.003498 $3485558.2700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 81 92 766.900789 $54787.3900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1046 1747 21248.655533 $1215423.1400 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 19 19 189.421429 $10834.9000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 7 7 72.785716 $5199.8000 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 24 25 135.028571 $9646.4400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2603 4560 55412.067120 $3958638.6100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 60 63 509.357143 $36388.4900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 371 639 7542.287530 $431117.1400 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 9 9 85.009524 $4859.1500 $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 26 123.884919 $8850.3400 $71.4400
PHY -97110TLHM PT SESSION BY PT ASST 1 1 14.714286 $841.0700 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 3.377778 $219.5600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 16 27 17.474885 $3984.3000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 5 5 5.000000 $1140.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 18 25 45.205557 $20613.8000 $456.0000
SENS -V5264 EARMOLD 98 145 251.279456 $4523.0400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3982 6365 80441.433305 $5746736.4100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 129 141 1165.820627 $83286.2300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 52 75 801.097622 $45822.7800 $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 14 135.928572 $9710.7300 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 46 49 277.396031 $19817.1700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 383 614 6625.578305 $91963.0200 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 4.142857 $57.5000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 110 134 840.490073 $31098.1500 $37.0000
TRAV -TRAVS Travel by mile 3449 10810 1713066.684605 $762314.6800 $0.4500
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Subtotal (Total Children Is Unduplicated) 22657 122648 2813091.832806 $50693909.5400 $18.0200
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Total 145452 3089461.376067 $61216831.7300 $19.8100
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Number of Children (Unduplicated) With at Least One Authorization 23998