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
Eligibility Filter: Program Patients
With the filters selected there were 71519 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 670 730 2137.893640 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 2.571429 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 202 224 11865.196437 $439012.2700 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 868 956 14007.628173 $439085.0400 $31.3500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 303 393 341.735257 $16574.1600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 35 38 43.913546 $2480.6700 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 13 14 12.555555 $247.4700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 728 749 800.109522 $18794.5700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 63 69 62.900000 $872.4200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 131 138 99.276327 $2352.8400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 67 74 61.118721 $554.9600 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 3 3.000000 $29.8800 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 88 96 85.899999 $2390.5900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 25 25 28.877777 $1110.9300 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 85 94 110.562372 $9380.1100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 28 30 31.122689 $1589.4400 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 99 105 99.023809 $1653.7000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 77 80 95.025006 $2128.5600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 53 64 50.954338 $2292.9700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 28 32 20.058067 $2306.6700 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 46 50 45.905708 $2295.2900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 7.000000 $350.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 572 580 1000.923964 $50046.1800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 65 65 133.600794 $10020.0700 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 19 19 33.016590 $2476.2500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 14.500000 $1087.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 16.005479 $1200.4100 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 9 9 14.005479 $1050.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 40 53 95.557534 $7166.8200 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 153 159 296.215645 $16439.9800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 19 19 21.596956 $1198.6300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 375 375 712.117806 $53408.8400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 362 364 714.180972 $53563.5800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 184 185 357.987671 $26849.0800 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 116 118 233.005479 $17475.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 43 43 72.008219 $5400.6200 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 152 153 285.164383 $21387.3200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 608 617 1113.348327 $61790.8600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 130 132 247.021917 $13709.7200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 344 381 679.938220 $50995.4000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 14 14 27.000000 $2025.0000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.571429 $78.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 17 57.780956 $2889.0700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 116 135 60.903313 $3109.0900 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 13 14 4.783865 $244.2100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 16 17 11.011112 $562.1200 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 2 0.511111 $26.0900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 109 119 132.645184 $6771.5400 $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 798 899 576.952605 $29453.3900 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 6 6 3.253652 $166.1000 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.316667 $16.1700 $51.0600
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 9 9 17.878245 $912.6900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 66 73 31.763634 $1621.5400 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 7 8 3.377778 $172.4400 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 2 3 5.000000 $255.2500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 6.511111 $332.3900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 71 79 50.395130 $2572.6700 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 3 0.350000 $17.8700 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 4 4 0.857534 $43.7800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 522 611 417.361551 $21306.2800 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 4 4 0.846499 $43.2100 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 6 6 1.496880 $76.4200 $51.0500
SCREEN-T1023 SCREENING 142 152 152.077776 $7603.8800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 7 21.851533 $327.7700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 28 30 39.733801 $2028.4200 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 4.000000 $204.2000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 44 45 46.379832 $2367.6900 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.511111 $26.0900 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 1.411111 $72.0400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1007 1139 669.180731 $34161.6300 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 46 47 25.314760 $1292.3000 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.950000 $99.5500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 34 37 24.479278 $1249.6600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 99 101 92.716666 $4733.1800 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.005556 $0.2900 $51.4600
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.327778 $16.7300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 139 144 138.461915 $6168.4700 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 5 3.511720 $156.4500 $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
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5438 9117 10699.796849 $597631.5700 $55.8500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 310 414 433.902130 $2169512.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 24 30 90.215870 $4510.7900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 71 84 121.852254 $6092.6300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 5 5 8.285714 $593.3400 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 29 30 36.724603 $2629.8500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 92 100 129.480931 $29780.6500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1124 1471 1519.147769 $75957.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 75 88 80.950497 $4047.5400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 381 489 492.344007 $12308.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3329 4110 8704.191611 $435209.9600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 149 164 231.115090 $11555.8000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 363 423 554.884122 $13872.0900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2450 3142 5182.834409 $259141.5900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 151 164 237.393644 $11869.6500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 162 272 404.309541 $10107.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1350 1677 2909.498359 $145475.0600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 109 122 176.118258 $8805.9300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 64 127 164.276390 $4106.9100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3929 4687 7479.333835 $373966.6300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 194 209 294.543463 $14727.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 377 427 529.868243 $13246.6800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.000000 $73.3200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 327 394 5495.165074 $137379.2100 $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 3 3 15.685714 $784.2900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11933 14845 123078.008521 $6153906.7300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 908 1037 7220.960988 $361048.4800 $50.0000
INTR -T1013 INTERPRETER 241 306 1657.349787 $82867.5300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6818 10965 75933.148771 $759332.3900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2044 2477 18171.560890 $1298177.2600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 109 119 661.996820 $47293.0700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 456 531 4104.030163 $234750.6700 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 17 19 113.828572 $6511.0000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 19 23 176.571428 $12614.2800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 92 106 648.691263 $46342.5500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2039 2522 18303.429131 $1307597.8400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 85 106 647.819049 $46280.2000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 119 149 1150.691270 $65773.5500 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 16 17 114.649999 $6553.4100 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 14 17 123.361906 $8812.9800 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 88 102 665.848408 $47568.2300 $71.4400
RSPT -RSPT RESPITE 1 1 13.142857 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 14 15 9.437139 $613.4200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 3 0.438357 $49.9800 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 14 15 14.640488 $3338.0100 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 9 11 11.438965 $2608.0700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 19 22 20.199999 $9211.1500 $456.0000
SENS -V5264 EARMOLD 80 98 161.537526 $2907.6700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3812 4643 35840.793692 $2560468.5000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 207 228 1354.854410 $96790.8400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 15 88.857144 $5082.6300 $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 48 54 465.642855 $33265.5600 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 115 131 950.585712 $67909.9200 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 161 180 1427.549994 $19814.4100 $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 22 23 53.796827 $1990.4900 $37.0000
TRAV -TRAVS Travel by mile 2076 4022 320985.715543 $142838.6600 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 17375 61446 649523.543653 $17180361.0300 $26.4500
-------------------------------------------------------------------------------------------------------------------------------------
Total 71519 674230.968675 $18217077.6300 $27.0200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 18410