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 40332 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 655 712 2110.988880 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 40 43 1451.304365 $53698.2600 $37.0000
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Subtotal (Total Children Is Unduplicated) 696 756 3564.259912 $53771.0300 $15.0900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 267 340 300.084802 $14554.1200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 8.000000 $451.9200 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 1.844444 $36.3500 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 465 477 517.131744 $12147.4300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 18 19 16.155554 $224.0800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 18 19 15.477777 $366.8200 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 19 21 14.690942 $133.3900 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 3 3.000000 $29.8800 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 20 21 15.438887 $429.6600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 8 8 8.333333 $320.5800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 22 24 36.784595 $3120.8100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 7 8 4.879833 $249.2200 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 18 19 15.127777 $252.6300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 19 19 26.720896 $598.5500 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 15 14.122907 $635.5400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 6 2.406316 $276.7200 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 43 46 41.580289 $2079.0100 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 7.000000 $350.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 563 571 986.923964 $49346.1800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 15 15 26.872223 $2015.4200 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 7 7 12.005479 $900.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 5.500000 $412.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $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 62 62 103.656545 $5752.9400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 9 9 6.588737 $365.6700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 48 48 95.000000 $7125.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 42 42 80.106849 $6008.0100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 30 30 58.500000 $4387.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 7 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 10 10 14.505479 $1087.9100 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 36 36 65.109589 $4883.2100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 100 102 182.834245 $10147.3000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 33 33 63.002740 $3496.6500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 42 46 90.076712 $6755.7500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.571429 $78.5700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 16 17 22.261905 $1136.4700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 1.672222 $85.3700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 16 21 15.516591 $792.1200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 86 97 67.248726 $3433.0500 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 0.763166 $38.9600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 11 11 7.500000 $382.8800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 7 3.386682 $172.8900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 53 66 62.949207 $3213.5600 $51.0500
SCREEN-T1023 SCREENING 7 7 6.277777 $313.8900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.210959 $3.1700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 3.511111 $179.2400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 118 137 81.712850 $4171.4300 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.511111 $26.0900 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 2.000000 $102.1000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 15 15 14.255556 $727.7500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 19 19 24.188888 $1077.6100 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.300000 $15.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 1891 2505 3194.300838 $157744.4500 $49.3800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 82 101 98.965677 $494828.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 4.044444 $202.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 24 27 27.604111 $1380.2200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.377778 $98.6600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 21 23 40.930158 $9413.9500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1018 1335 1344.512578 $67225.7300 $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 216 251 221.924933 $5548.1900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3286 4058 8655.363834 $432768.5700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 149 164 231.115090 $11555.8000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 359 419 552.534122 $13813.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2417 3105 5118.213535 $255910.5400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 151 164 237.393644 $11869.6500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 159 269 402.200017 $10055.0400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1324 1645 2867.455502 $143372.9200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 109 122 176.118258 $8805.9300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 62 125 160.698612 $4017.4700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3890 4643 7446.075391 $372303.7300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 194 209 294.543463 $14727.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 371 421 524.386497 $13109.6400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 12 54.736508 $1368.4100 $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 2404 2919 24873.641104 $1243683.4900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 188 209 1579.143643 $78957.2900 $50.0000
INTR -T1013 INTERPRETER 218 279 1564.257724 $78212.9200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6816 10961 75894.596391 $758946.8700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 259 310 2392.702368 $170934.8500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 9 9 36.896826 $2635.9100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 55 61 451.253971 $25811.7300 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 5.571429 $318.6800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 3 5 16.123810 $1151.8800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 27.704761 $1979.2300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 250 304 2330.361105 $166481.0900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 2 2 7.428571 $530.7000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 12 13 103.453174 $5913.4000 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 3 23.714286 $1694.1500 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 3 4 6.572222 $469.5200 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.210959 $78.7200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.210959 $24.0500 $114.0200
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 5.533333 $1261.5900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 3 4.044444 $922.1200 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 8 6.377777 $2908.2300 $455.9900
SENS -V5264 EARMOLD 13 15 18.255553 $328.6000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 569 653 5218.240458 $372791.4300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 23 26 139.236508 $9947.0700 $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 4 4 24.857142 $1775.8000 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 7 8 74.228571 $5302.9000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 24 27 247.123809 $3430.0800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 22 23 53.796827 $1990.4900 $37.0000
TRAV -TRAVS Travel by mile 2075 4019 320953.296496 $142824.2300 $0.4500
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Subtotal (Total Children Is Unduplicated) 12010 37071 464632.536806 $4959423.8300 $10.6700
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Total 40332 471391.097556 $5170939.3000 $10.9700
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Number of Children (Unduplicated) With at Least One Authorization 13138