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: 10-01-20 and 12-31-20 Date of Report: 01-23-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 48353 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 1 1 1.966667 $72.7700 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 501 545 1791.066652 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 143 162 9525.114295 $352429.2400 $37.0000
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Subtotal (Total Children Is Unduplicated) 640 708 11318.147614 $352502.0000 $31.1400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 197 255 225.706034 $10946.7500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 21 24 22.402435 $1265.5100 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 5 4.544444 $89.5700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 494 512 543.199998 $12759.7700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 26 29 20.094445 $278.7100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 78 81 49.979829 $1184.5100 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 19 22 19.038889 $172.8700 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 27 31 28.994444 $806.9100 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 7 7 5.544444 $213.2900 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 39 45 47.361111 $4018.1200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 11 12 11.315079 $577.8600 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 47 53 53.684920 $896.5400 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 32 34 35.042999 $784.9700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 21 25 19.409285 $873.4300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 13 6.063623 $697.3100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 36 39 35.269178 $1763.4600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 7.000000 $350.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 416 420 721.266744 $36063.3200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 37 37 69.500000 $5212.5000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 11 11 19.005479 $1425.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 6.500000 $487.5000 $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 6 6 9.005479 $675.4100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 7 7 11.005479 $825.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 30 43 76.557534 $5741.8200 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 85 89 145.301598 $8064.2400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 11 11 15.010959 $833.1000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 259 259 487.617806 $36571.3400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 263 264 520.074123 $39005.5700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 117 118 227.487671 $17061.5800 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 81 83 163.005479 $12225.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 25 25 43.002740 $3225.2000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 97 98 188.054794 $14104.1100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 409 415 743.673965 $41273.9300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 85 87 164.019177 $9103.0700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 228 250 443.412194 $33255.9500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 10 10 19.000000 $1425.0000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.571429 $78.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 9 36.314287 $1815.7200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 77 89 29.006022 $1480.7500 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 13 14 4.783865 $244.2100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 10 10 4.500001 $229.7300 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 2 0.511111 $26.0900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 69 72 89.819755 $4585.3100 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 6 6 4.505555 $230.0100 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.175342 $8.9500 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 531 591 392.810350 $20052.9400 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 1.294444 $66.0800 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.316667 $16.1700 $51.0600
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 1.022222 $52.1800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 49 55 21.767134 $1111.2100 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 6 7 3.372222 $172.1500 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 3 5.000000 $255.2500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 5.000000 $255.2500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 46 50 31.528617 $1609.5500 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 0.194444 $9.9200 $51.0400
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 3 3 0.800000 $40.8400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 352 402 277.645754 $14173.8000 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 4 4 0.846499 $43.2100 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 4 4 0.552436 $28.2100 $51.0600
SCREEN-T1023 SCREENING 82 88 88.511110 $4425.5500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 3.066667 $46.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 13 14 13.827778 $705.9100 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 27 27 31.896499 $1628.3200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 588 653 374.906158 $19138.9500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 32 32 16.648095 $849.8800 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.438889 $22.4100 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 22 24 17.383006 $887.4000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 59 61 54.772221 $2796.1200 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.327778 $16.7300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 85 90 92.312459 $4112.5200 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 4 3.355556 $149.4900 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.100000 $4.4600 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.300000 $15.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3551 5768 6831.336750 $386540.9200 $56.5800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 188 245 265.094282 $1325472.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 10 17.455555 $872.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 29 32 39.172224 $1958.6200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 3 6.285714 $450.1200 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 26 27 34.346825 $2459.5700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 40 42 48.292998 $11107.3900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 772 1015 985.987716 $49299.4800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 44 52 45.859161 $2292.9700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 237 301 308.548957 $7713.7700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2341 2898 5942.892144 $297144.8400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 92 106 143.421437 $7171.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 268 317 436.023009 $10900.5600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1644 2102 3430.012749 $171500.5300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 101 111 166.019042 $8300.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 120 209 319.476202 $7986.9400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 976 1206 2054.229399 $102711.6300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 82 95 138.087305 $6904.3800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 43 88 119.700004 $2992.5100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2571 3085 4744.083162 $237204.1600 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 128 137 183.434918 $9171.7400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 274 317 401.834912 $10045.8500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.000000 $73.3200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 237 287 3732.428564 $93310.7700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 4 2.272222 $113.6100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 14.542857 $727.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8641 10729 89688.870216 $4484447.9600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 662 759 5210.154650 $260508.0300 $50.0000
INTR -T1013 INTERPRETER 215 276 1496.521216 $74826.1000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4871 7754 53966.793312 $539668.5700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1296 1564 11413.994440 $815416.3100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 68 74 412.545234 $29472.2400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 319 370 2844.865874 $162726.4400 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 13 14 78.521428 $4491.4300 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 11 13 124.028571 $8860.6100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 68 79 447.084916 $31939.8000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1322 1616 11700.199764 $835862.7100 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 58 72 427.324607 $30528.0800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 85 106 819.416669 $46837.8800 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 9 10 70.071428 $4005.2900 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 10 12 83.647620 $5975.7900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 62 69 430.471425 $30752.9000 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 4.320548 $280.8400 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 5 6 1.833182 $417.9500 $227.9900
SENS -V5060 BEHIND EAR HEARING AID 5 5 4.394521 $1001.9500 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 7 4.811111 $2193.8600 $456.0000
SENS -V5264 EARMOLD 34 40 49.016286 $882.2900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1967 2383 18498.934891 $1321565.0700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 91 98 601.890475 $42999.0600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 10 62.928572 $3599.5200 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 3 3 31.714286 $1814.0600 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 35 39 355.419045 $25391.1700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 70 80 589.014286 $42079.2200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 101 112 830.311903 $11524.7400 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 25.857143 $358.9000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 15 16 34.687303 $1283.4300 $37.0000
TRAV -TRAVS Travel by mile 1482 2859 237238.257620 $105571.0400 $0.4500
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Subtotal (Total Children Is Unduplicated) 11931 41877 461128.403900 $11295170.4000 $24.4900
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Total 48353 479277.888264 $12034213.3200 $25.1100
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Number of Children (Unduplicated) With at Least One Authorization 12666