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 41646 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 614 700 2134.886508 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 24 25 1625.239683 $60133.8700 $37.0000
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Subtotal (Total Children Is Unduplicated) 641 728 3763.437303 $60256.3900 $16.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 296 367 346.507492 $16805.6200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 4 4.000000 $225.9600 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 5 2.016667 $39.7500 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 437 450 500.451131 $11755.5900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 17 20 15.161110 $210.2800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 11 11 10.000000 $237.0000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 18 22 14.691018 $133.3900 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 2.000000 $19.9200 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 18 21 13.444443 $374.1500 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 7 8.500000 $327.0000 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 23 27 46.238640 $3922.9000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 6 7 5.079908 $259.4300 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 16 18 13.300000 $222.1100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 16 17 13.257686 $296.9700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 10 12 4.322528 $194.5200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 8 6.744674 $775.6500 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 32 37 72.097839 $3604.9000 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 5 9.000000 $450.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 546 548 892.144055 $44607.1900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 17.511111 $1313.3300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 6.500000 $487.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 38 38 65.378995 $3628.5400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 7.000000 $388.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 62 62 116.000000 $8700.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 58 58 111.752054 $8381.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 32 32 64.000000 $4800.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 9 9 18.000000 $1350.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 7 7 23.857143 $1789.2800 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 51 51 93.763012 $7032.2300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 118 119 231.678082 $12858.1300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 30 30 56.010958 $3108.6100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 34 36 73.000000 $5475.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 2.366667 $118.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.100000 $5.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 12 13 11.339682 $578.8900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 1.227778 $62.6800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 15 17 13.573059 $692.9100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 98 108 75.103760 $3834.0500 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 2 0.246575 $12.5900 $51.0600
PSTF -97164 PT RE-EVAL EST PLAN CARE 9 9 3.377778 $172.4400 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 8 6.344444 $323.8800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 53 62 73.982921 $3776.8300 $51.0500
SCREEN-T1023 SCREENING 11 11 11.000000 $550.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 5.211111 $266.0300 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 127 146 77.524831 $3957.6500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 4.000000 $204.2000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 12 12 13.455556 $686.9100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 16 17 14.583333 $649.6900 $44.5500
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Subtotal (Total Children Is Unduplicated) 1880 2483 3202.846041 $161521.1700 $50.4300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 80 96 336.685026 $1683425.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 6.766667 $338.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 24 30 30.609130 $1530.4500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 3.005479 $215.2200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 32 35 59.941270 $13786.5000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1106 1509 1598.053945 $79902.8800 $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 208 231 198.723614 $4968.1200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3298 4210 8249.647492 $412482.2200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 169 192 328.263495 $16413.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 366 445 514.492462 $12862.3200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2600 3422 5464.599988 $273229.9600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 156 180 277.972222 $13898.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 170 316 381.840479 $9546.0200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1211 1585 2650.228323 $132511.3600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 109 126 203.654757 $10182.7200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 70 147 176.633331 $4415.8300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3945 4796 7512.067851 $375603.4900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 214 241 347.401961 $17370.1400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 394 475 523.938492 $13098.4600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.000000 $73.3200 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 1.933333 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 12 32.061110 $801.5300 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 5.857143 $292.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2430 3160 23499.942085 $1174996.0600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 129 158 1003.255558 $50162.7100 $50.0000
INTR -T1013 INTERPRETER 248 326 1744.836756 $87241.8200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6745 11126 73541.311139 $735412.4100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 257 311 2058.966671 $147092.4400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 5 5 15.246031 $1089.1800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 39 46 314.377779 $17982.3900 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 12.000000 $857.2800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 5 31.838096 $2274.5100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 231 273 1952.076188 $139456.2400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 2.900000 $207.1800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 10 59.214286 $3384.6800 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 5.500000 $314.3800 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 3 24.571428 $1755.3900 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 3 4 13.679364 $977.2400 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 3 2.011111 $130.7200 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 6 6 5.613167 $1279.8300 $228.0100
SENS -V5060 BEHIND EAR HEARING AID 4 7 5.111110 $1165.3100 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 8 7.311111 $3333.8600 $456.0000
SENS -V5264 EARMOLD 16 21 16.090943 $289.6400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 555 675 5015.871431 $358333.4900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 16 18 113.954761 $8140.9300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.142857 $122.5700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 6 7 42.714285 $3051.5100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 5 6 39.714286 $2837.1800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 13 14 100.114287 $1389.5900 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.000000 $83.2800 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 6 7 12.036508 $445.3500 $37.0000
TRAV -TRAVS Travel by mile 2053 4077 279692.552584 $124463.1700 $0.4400
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Subtotal (Total Children Is Unduplicated) 11922 38435 418345.218447 $5950163.2000 $14.2200
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Total 41646 425311.501791 $6171940.7500 $14.5100
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Number of Children (Unduplicated) With at Least One Authorization 13015