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 24986 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 494 536 1774.161891 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 92.400000 $3418.8000 $37.0000
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Subtotal (Total Children Is Unduplicated) 499 541 1868.528558 $3491.5700 $1.8700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 184 238 212.253980 $10294.3300 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 427 439 465.144443 $10926.2400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 2.022222 $28.0500 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 3.000000 $71.1000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.022222 $9.2800 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.022222 $28.4500 $27.8300
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 3.000000 $254.5200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.116667 $5.9600 $51.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 3 3.000000 $50.1000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 2.000000 $44.8000 $22.4000
EVAL -96111 DEVELOPMENTAL EVALUATION 35 38 33.269178 $1663.4600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 7.000000 $350.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 412 416 713.266744 $35663.3200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 0.005479 $0.4100 $75.2900
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 7.374201 $409.2700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 1.002740 $55.6500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 0.500000 $37.5000 $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 9 9 15.013699 $833.2600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 8 16.500000 $1237.5000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.571429 $78.5700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.738889 $37.7200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 24 27 23.867123 $1218.4200 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.172222 $8.7900 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 11 6.222223 $317.6500 $51.0500
SCREEN-T1023 SCREENING 2 2 2.044444 $102.2200 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 17 19 11.105555 $566.9400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 7.653968 $340.9900 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.300000 $15.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 1128 1268 1578.361872 $67409.4000 $42.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 29 36.451674 $182258.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 3.800000 $190.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 10 10 10.844445 $542.2300 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.066666 $245.3200 $229.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 722 955 910.252151 $45512.6900 $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 146 169 160.352955 $4008.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2313 2863 5911.658812 $295583.1800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 92 106 143.421437 $7171.1100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 265 314 434.184120 $10854.5900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1624 2080 3383.532590 $169176.5200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 101 111 166.019042 $8300.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 118 207 317.833345 $7945.8600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 959 1185 2029.418287 $101471.0700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 82 95 138.087305 $6904.3800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 87 116.633337 $2915.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2550 3060 4730.958735 $236547.9500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 128 137 183.434918 $9171.7400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 269 312 398.353166 $9958.8100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 3.142857 $78.5700 $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 1 1 13.142857 $657.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 240 287 2376.296809 $118814.9600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 19 22 157.254762 $7862.7400 $50.0000
INTR -T1013 INTERPRETER 198 255 1435.857724 $71792.9200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4870 7753 53953.650455 $539537.1400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 41 50 336.542851 $24042.6500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 4 4 21.000001 $1500.2400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 11 12 65.368255 $3739.0600 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 5.571429 $318.6800 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 13.142857 $938.9300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 40 44 329.257144 $23522.1300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.428571 $316.3800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 2 15.428571 $881.9000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 1.522222 $694.1200 $455.9900
SENS -V5264 EARMOLD 2 2 1.522222 $27.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 66 74 597.866667 $42711.6100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 27.857143 $1990.1200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 16.142857 $923.3700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 2.285714 $163.2900 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 14.000000 $1000.1600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 5.142857 $71.3800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 15 16 34.687303 $1283.4300 $37.0000
TRAV -TRAVS Travel by mile 1481 2858 237225.114763 $105565.1900 $0.4500
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Subtotal (Total Children Is Unduplicated) 7763 23177 315781.661259 $2049664.6500 $6.4900
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Total 24986 319228.551689 $2120565.6100 $6.6400
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Number of Children (Unduplicated) With at Least One Authorization 8632