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
Eligibility Filter: Program Patients
With the filters selected there were 119342 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 1458 1808 5753.020710 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 9 10 79.574603 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 345 390 33516.461132 $1240109.0800 $37.0000
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Subtotal (Total Children Is Unduplicated) 1801 2215 39364.200890 $1240669.4300 $31.5200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 499 808 820.321542 $39785.6400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 18 19 23.079376 $1303.7600 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 10 7.472224 $147.2800 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1040 1121 1231.626192 $28930.9000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 18 27 28.933334 $401.3100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 23 29 27.044444 $640.9500 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 26 41 38.072527 $345.7000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 30 42 43.061112 $1198.3900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 11 13.294445 $511.4400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 24 29 30.044751 $2549.0200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 12 14 6.133638 $313.2500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 25 34 33.488097 $559.2500 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 14 23 19.339193 $433.2000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 21 31 90.432866 $4069.4900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 18 19.533332 $2246.3200 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 2 2 27.000000 $1316.5200 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 118 145 124.542195 $6227.1200 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 2494 2595 4402.703488 $220135.1800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 23 23 24.219177 $1816.4400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 55 58 47.504872 $3562.8800 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 3.008296 $225.6200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 13 8.502512 $637.6900 $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 18 18 16.597653 $1244.8200 $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 25 31 25.255406 $1894.1200 $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 146 154 133.137349 $7389.0500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 23 23 14.616438 $811.2000 $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 336 339 298.653449 $22398.9200 $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 111 111 174.174165 $13063.0700 $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 159 160 41.115099 $3083.5100 $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 597 600 681.625848 $37830.1500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 35 37 33.098628 $1836.9800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 249 272 405.869877 $30440.1400 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 3 3 3.002740 $225.2000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 10 79.438093 $3971.9000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 7 37.785713 $1889.2800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 26 35 19.222225 $981.3100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 9 9 6.744444 $344.3000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 41 48 61.482303 $3138.6800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 242 287 295.274973 $15073.7900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 31 46 32.055556 $1636.4400 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 4.472222 $228.3100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 17 20 15.679832 $800.4600 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 149 220 192.089740 $9806.1900 $51.0500
SCREEN-T1023 SCREENING 42 44 70.229366 $3511.4700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 5 3.472668 $52.0900 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 8 8 5.551066 $283.3800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 13 14 13.133333 $670.4600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 313 384 394.771206 $20153.0700 $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 8 8 6.079148 $310.3400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 64 66 108.660743 $4840.8300 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.816666 $90.8300 $50.0000
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Subtotal (Total Children Is Unduplicated) 5783 8137 10325.622543 $511143.4500 $49.5000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 190 269 317.527929 $1587641.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 11 14 15.634246 $781.7100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 55 75 119.063123 $5953.1600 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.428571 $102.3000 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 6 4.855555 $347.7000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 56 61 73.349542 $16870.3600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3454 4905 5902.727335 $295137.2600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 58 65 57.788847 $2889.4500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 685 782 637.338119 $15933.5500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 7040 11694 39495.122531 $1974755.7600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 73 87 131.492063 $6574.6000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 859 1367 3545.172418 $88629.3000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 4379 7497 20488.922972 $1024446.0700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 62 67 77.352375 $3867.5900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 362 831 2122.830945 $53070.7600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2574 4268 12842.485042 $642124.2100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 47 51 61.399998 $3069.9900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 127 299 855.008737 $21375.2400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7560 11923 30037.422572 $1501870.5500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 92 99 113.158726 $5657.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 852 1276 3143.320627 $78583.0000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 8 55.050793 $4036.3200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 90 132 1543.316663 $38582.9300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 43.979365 $2198.9700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5565 8906 132394.516887 $6619726.5700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 238 268 2431.552371 $121577.6400 $50.0000
INTR -T1013 INTERPRETER 693 1007 7276.976326 $363848.8200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 14547 33984 392633.749993 $3926337.7500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 558 817 10028.429348 $716431.1000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 9 11 68.259525 $4876.4500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 201 293 3530.438097 $201941.0600 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 3 3 36.571428 $2091.8800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 4 5 40.695239 $2907.2700 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 11.000000 $785.8400 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 653 1048 12693.813891 $906846.2200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 5 5 21.766666 $1555.0100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 37 51 785.326190 $44889.2600 $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 14.588889 $1042.2300 $71.4400
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 8 7.159514 $465.3700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 5 2.681278 $305.6700 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 8 10 12.213546 $2784.6600 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 14 19 26.161187 $11929.5100 $456.0000
SENS -V5264 EARMOLD 40 51 68.402435 $1231.2400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1326 1914 25032.884410 $1788349.4600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 35 39 291.568253 $20829.6300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 11 12 195.819047 $11200.8500 $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 59.857144 $4276.1900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 69 78 1093.904765 $15183.3800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 158 192 1314.556741 $48638.6300 $37.0000
TRAV -TRAVS Travel by mile 4628 14461 2185128.111413 $972382.0200 $0.4500
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Subtotal (Total Children Is Unduplicated) 24630 108990 2896896.967963 $23167748.1600 $8.0000
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Total 119342 2946586.791396 $24919561.0400 $8.4600
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Number of Children (Unduplicated) With at Least One Authorization 26778