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 76697 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 1120 1402 4621.083998 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 9 10 79.574603 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 69 80 6429.823815 $237903.4800 $37.0000
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Subtotal (Total Children Is Unduplicated) 1200 1499 11145.626861 $238463.8300 $21.4000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 358 574 605.820622 $29382.2900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.027778 $171.0400 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 905 970 1042.058730 $24477.9600 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.072222 $25.4100 $23.7000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 3 6.000000 $230.8200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 6.166667 $523.1800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 0.705556 $36.0400 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.044444 $23.3900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.022222 $46.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.511111 $288.7800 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 16.428571 $801.0600 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 101 123 101.822142 $5091.1200 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 1788 1847 3117.532787 $155876.6400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 7 8.012328 $600.9300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 2.006849 $150.5200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.175342 $163.1500 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 9 6.914536 $518.5800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 29 31 23.190173 $1287.0400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 3.013698 $167.2600 $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 59 59 93.041098 $6978.0700 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 30 30 52.021916 $3901.6500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 19 19 16.039727 $1202.9600 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 111 113 171.679450 $9528.2100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 49 53 96.079452 $7205.9600 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 10 79.438093 $3971.9000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 6 33.285713 $1664.2800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 5 1.061110 $54.1600 $51.0400
OCTH -97165 OT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 10 10 8.511112 $434.5000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 70 82 89.646653 $4576.4700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 6 2.388889 $121.9500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 6 7.000000 $357.3500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 35 48 35.993761 $1837.4900 $51.0500
SCREEN-T1023 SCREENING 5 5 5.000000 $250.0000 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 2 3 3.038889 $155.1400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 89 100 90.014159 $4595.2300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 15 15 34.049207 $1516.8900 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.816666 $90.8300 $50.0000
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Subtotal (Total Children Is Unduplicated) 3441 4189 5806.137152 $270455.7900 $46.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 68 92 136.328693 $681644.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 12 12.923135 $646.1500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 32 44 74.819439 $3740.9700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 2.022222 $144.8100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 19 19 19.044444 $4380.2100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2483 3575 4415.768860 $220788.9800 $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 491 548 466.164390 $11654.1600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5024 8363 28109.103230 $1405454.7800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 43 53 74.108731 $3705.4400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 674 1082 2944.029361 $73600.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2935 5088 13903.415842 $695170.7800 $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 1907 3109 9221.418672 $461070.8700 $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 5044 7900 19596.158291 $979807.5400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 61 68 74.486506 $3724.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 657 1002 2540.351583 $63508.7800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 46.161904 $3384.5900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 26 29 356.292856 $8907.3200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 43.979365 $2198.9700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1000 1452 20397.534104 $1019876.8000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 34 37 339.680950 $16984.0500 $50.0000
INTR -T1013 INTERPRETER 603 882 6193.040240 $309652.0300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 10619 24708 285178.174734 $2851781.9400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 127 164 1859.973007 $132876.4600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 8.857143 $632.7600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 62 86 1031.780159 $59017.8300 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 10.142857 $724.6100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 218 306 3114.596831 $222506.8600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.142857 $295.9700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 11 16 232.271428 $13276.6400 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.857143 $132.6700 $71.4400
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.377778 $89.5600 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 5 3.711111 $1692.2600 $456.0000
SENS -V5264 EARMOLD 18 20 18.911111 $340.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 281 385 4333.756320 $309603.5300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 7 54.357142 $3883.2800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 107.571429 $6153.0800 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.857143 $132.6700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 20 22 297.414286 $4128.1000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 109 133 840.204359 $31087.5800 $37.0000
TRAV -TRAVS Travel by mile 3448 10804 1710261.541748 $761066.3900 $0.4500
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Subtotal (Total Children Is Unduplicated) 16337 71009 2118817.812816 $10434583.2400 $4.9200
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Total 76697 2135769.576829 $10943502.8600 $5.1200
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Number of Children (Unduplicated) With at Least One Authorization 18001