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: 01-01-21 and 03-31-21 Date of Report: 05-04-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 49591 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 3 3 3.311112 $122.5100 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 468 542 1898.201590 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 123 138 13441.306348 $497328.3500 $37.0000
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Subtotal (Total Children Is Unduplicated) 589 683 15342.819050 $497450.8600 $32.4200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 214 265 271.240981 $13155.2200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 24 25 20.052891 $1132.7900 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 3.000000 $59.1300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 464 480 546.459861 $12836.3400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 26 28 19.950000 $276.7100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 82 88 51.345206 $1216.8800 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 23 26 17.966666 $163.1400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 35 39 29.527777 $821.7600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 6 5.000000 $192.3500 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 36 38 69.686508 $5912.2000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 12 12 22.668254 $1157.6700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 50 56 72.508730 $1210.9000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 37 40 39.330137 $880.9900 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 28 30 20.217197 $909.7700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 12 6.769711 $778.5300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 24 28 25.815298 $1290.7700 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 5 9.000000 $450.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 389 390 621.205645 $31060.2700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 37 37 69.249923 $5193.7400 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 13 13 19.019330 $1426.4500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 7.571429 $567.8600 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 3 3 3.011111 $225.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 7.000000 $525.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 9 9 17.000000 $1275.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 21 23 40.656165 $3049.2200 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 71 75 128.194358 $7114.7900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 6 11.000000 $610.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 318 318 611.818588 $45886.4000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 293 294 560.065749 $42004.9400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 157 157 310.066667 $23255.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 74 75 150.000000 $11250.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 32 32 62.500000 $4687.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 130 131 230.068488 $17255.1500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 479 480 882.265484 $48965.7500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 108 108 205.030135 $11379.1800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 224 233 412.380229 $30928.5200 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 6 7 12.000000 $900.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.400000 $70.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 7 20.857143 $1042.8600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 83 90 32.413246 $1654.7200 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 11 13 7.044444 $359.6200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 17 17 17.859524 $911.7300 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.500000 $25.5300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 80 88 82.140294 $4193.2700 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 0.205555 $10.4900 $51.0400
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 0.298630 $15.2500 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 545 635 427.260044 $21811.6300 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.338889 $17.3000 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 3 4 1.805556 $92.1800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 45 54 18.113241 $924.6800 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 8 9 5.205555 $265.7400 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 2 2 0.177701 $9.0700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 4.383333 $223.7700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 53 60 36.733942 $1875.2700 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 0.283333 $14.4600 $51.0400
PSTH -97163 PT EVAL HIGH COMPLEXITY 311 382 227.559555 $11616.9400 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 0.159437 $8.1400 $51.0400
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.172222 $8.7900 $51.0400
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 4 5 1.746575 $89.1600 $51.0500
SCREEN-T1023 SCREENING 54 56 52.955555 $2647.7800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 3.000000 $45.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 9.511111 $485.5400 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 19 20 16.329910 $833.6400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 582 673 368.795260 $18827.0400 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 22 23 13.538888 $691.1600 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 0.555556 $28.3600 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 33 33 26.835299 $1369.9400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 69 74 72.100000 $3680.7100 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.400000 $20.4200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 72 79 69.031799 $3075.3700 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 2.615068 $116.5000 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.611111 $27.2200 $44.5500
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Subtotal (Total Children Is Unduplicated) 3554 5948 7119.585773 $407450.1000 $57.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 199 251 271.936460 $1359684.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 10 15.822223 $791.1200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 25 31 30.733333 $1536.6700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $71.6100 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 40 42 69.082464 $4946.9900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 54 58 57.187758 $13153.1700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 821 1120 1178.167113 $58908.4700 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 53 56 53.091213 $2654.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 211 261 244.908698 $6122.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2319 2961 5589.238885 $279461.7700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 105 118 198.903968 $9945.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 257 316 393.939679 $9848.4900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1762 2320 3681.309707 $184065.4300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 110 124 195.676188 $9783.8100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 128 244 308.223808 $7705.5900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 875 1138 1847.242841 $92362.0800 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 80 92 149.214282 $7460.7100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 49 109 136.461106 $3411.5200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2620 3157 4871.550928 $243577.5400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 135 152 202.116669 $10105.8500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 277 337 409.446822 $10236.1600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 2.000000 $146.6400 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 1.933333 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 224 315 3504.142852 $87603.5400 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 3 8.857143 $442.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8631 11156 87139.702482 $4356980.9700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 624 771 4988.397617 $249419.6100 $50.0000
INTR -T1013 INTERPRETER 239 316 1666.188343 $83309.4000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4864 7937 53019.463524 $530194.1200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1333 1670 11078.914270 $791477.1300 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 51 58 332.104763 $23725.5200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 256 319 2394.206208 $136948.5000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 9 9 66.142857 $3783.3700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 11 15 115.793649 $8272.2900 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 72 88 441.617460 $31549.1300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1230 1544 10589.432906 $756508.7200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 51 63 417.887300 $29853.8500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 86 112 822.342858 $47005.0400 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 5 49.642858 $2837.5800 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 9 13 62.076189 $4434.7200 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 71 85 510.316664 $36456.9800 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 8 5.504261 $357.7800 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 4 5 6.328615 $1442.9200 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 4 2.943684 $671.1600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 8 5.599999 $2553.5500 $455.9900
SENS -V5264 EARMOLD 33 42 45.955860 $827.2100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1865 2332 16783.533838 $1199014.9900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 66 73 476.104763 $34012.9000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 49.785714 $2847.7400 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.000000 $343.2000 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 33 39 325.800002 $23275.1200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 70 79 588.671431 $42054.6600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 70 82 553.607400 $7684.0700 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 11.714286 $162.5900 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 5 6 11.536508 $426.8500 $37.0000
TRAV -TRAVS Travel by mile 1466 2894 213341.530364 $94936.9700 $0.4400
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Subtotal (Total Children Is Unduplicated) 11633 42960 429331.034146 $10907395.6200 $25.4100
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Total 49591 451793.438969 $11812296.5800 $26.1500
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Number of Children (Unduplicated) With at Least One Authorization 12329