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
Eligibility Filter: Program Patients
With the filters selected there were 74060 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 646 736 2230.246827 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 12.857143 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 175 198 16489.092062 $610096.4300 $37.0000
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Subtotal (Total Children Is Unduplicated) 819 938 18735.507144 $610218.9400 $32.5700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 327 412 378.678117 $18365.9100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 33 35 31.186224 $1761.7100 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 11 12 10.516667 $207.2800 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 706 727 817.138052 $19194.5700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 64 71 67.894445 $941.7000 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 130 138 96.772375 $2293.5100 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 75 86 70.564829 $640.7300 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 2.000000 $19.9200 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 98 108 95.507142 $2657.9600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 22 23 29.500000 $1134.8700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 87 98 130.981497 $11112.4900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 29 31 43.314829 $2212.0900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 105 117 128.432539 $2144.8200 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 88 95 102.597348 $2298.1800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 66 75 49.613011 $2232.6000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 31 37 23.271463 $2676.2600 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 33 39 76.097839 $3804.9000 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 5 9.000000 $450.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 561 563 915.144055 $45757.1900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 58 58 107.794367 $8084.5700 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 20 20 31.019330 $2326.4500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 7 7 11.571429 $867.8600 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 4 4 4.011111 $300.8300 $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 13 13 24.000000 $1800.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 34 36 67.156165 $5036.7200 $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 117 122 202.691161 $11249.3700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 10 10 18.000000 $999.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 484 484 932.818588 $69961.4000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 417 418 798.817803 $59911.3500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 234 234 464.566667 $34842.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 103 104 208.000000 $15600.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 49 49 105.357143 $7901.7800 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 200 201 356.831500 $26762.3900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 710 712 1334.438087 $74061.3200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 150 150 285.041093 $15819.7900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 305 322 571.838546 $42887.9000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 11 12 22.000000 $1650.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 3.766667 $188.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 16 31.057143 $1552.8600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 127 139 55.030708 $2809.3500 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 12 14 7.433333 $379.4700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 22 22 21.415079 $1093.2400 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.500000 $25.5300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 122 135 116.114940 $5927.6800 $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 858 999 675.323968 $34475.2800 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 2.338889 $119.4000 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 8 10 4.591020 $234.3800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 60 73 23.737594 $1211.8000 $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 3 3 0.349923 $17.8600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 7 9 7.827778 $399.6100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 80 90 59.629973 $3044.1100 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 1.500000 $76.5800 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 4 4 0.560045 $28.5900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 478 589 384.810577 $19644.5900 $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 5 6 2.746575 $140.2100 $51.0500
SCREEN-T1023 SCREENING 102 104 100.955555 $5047.7800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 10 24.798499 $371.9800 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 28 28 23.210860 $1184.9100 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 3 3 5.000000 $255.2500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 33 34 28.174354 $1438.3000 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 0.061111 $3.1200 $51.0400
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 1.038889 $53.0400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1061 1244 748.342293 $38202.8600 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 33 34 20.022221 $1022.1300 $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 46 46 35.050672 $1789.3400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 110 116 128.677778 $6569.0000 $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 127 136 111.996181 $4989.4200 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 2.727397 $121.5100 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.611111 $71.7700 $44.5500
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Subtotal (Total Children Is Unduplicated) 5555 9541 11273.572468 $633693.2200 $56.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 315 399 638.776281 $3193883.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 21 29 39.024604 $1951.2400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 72 89 236.342629 $11817.1500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 2.000000 $143.2200 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 46 48 75.393575 $5398.9300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 116 127 170.639737 $39247.1500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1229 1683 1825.127091 $91256.5500 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 87 96 98.887055 $4944.3600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 346 428 401.683165 $10042.1100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3334 4255 8307.386378 $415369.1500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 169 192 328.263495 $16413.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 371 451 517.981350 $12949.5400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2629 3456 5501.932581 $275096.5700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 156 180 277.972222 $13898.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 172 318 382.934923 $9573.3800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1236 1614 2686.440227 $134321.9600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 109 126 203.654757 $10182.7200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 73 151 181.327775 $4533.1900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3982 4840 7545.225536 $377261.3700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 214 241 347.401961 $17370.1400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 402 483 535.699603 $13392.4900 $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 322 449 5236.292054 $130907.2600 $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 11991 15565 120015.563622 $6000772.5400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 837 1032 6639.997623 $331999.5100 $50.0000
INTR -T1013 INTERPRETER 266 348 1816.533582 $90826.6500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6747 11133 73566.896855 $735668.2700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2111 2682 17513.873783 $1251190.3900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 83 97 547.910316 $39142.6800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 372 464 3398.670497 $194403.7900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 14 15 117.999999 $6749.6000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 17 21 170.288888 $12165.4300 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 94 113 606.012698 $43293.5300 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1902 2455 16686.474186 $1192081.1300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 79 96 658.387300 $47035.1500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 117 148 1083.985717 $61960.5200 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 9 10 84.142858 $4809.6000 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 15 20 115.076189 $8221.0400 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 97 120 748.186506 $53450.3600 $71.4400
RSPT -RSPT RESPITE 1 1 1.142857 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 14 15 10.070470 $654.5800 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 2 0.246575 $28.1100 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 15 19 19.267962 $4393.1300 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 10 15 12.054794 $2748.4700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 25 29 28.133180 $12828.6900 $456.0000
SENS -V5264 EARMOLD 83 112 160.062853 $2881.1300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3739 4803 33863.958383 $2419239.7300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 151 178 1035.317285 $73963.0000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 9 9 66.928571 $3828.3200 $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 46 54 423.942858 $30286.4500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 114 130 946.876194 $67644.7600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 124 140 973.264545 $13508.9100 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 17.714286 $245.8700 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 6 7 12.036508 $445.3500 $37.0000
TRAV -TRAVS Travel by mile 2054 4082 279713.304966 $124472.4000 $0.4400
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Subtotal (Total Children Is Unduplicated) 17064 63581 596613.500381 $17621825.5200 $29.5400
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Total 74060 626622.579993 $18865737.6700 $30.1100
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Number of Children (Unduplicated) With at Least One Authorization 18054