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: 04-01-21 and 06-30-21 Date of Report: 07-15-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 50102 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 8.088889 $299.2900 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 514 575 1167.583312 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 152 177 21108.511904 $781014.9400 $37.0000
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Subtotal (Total Children Is Unduplicated) 665 755 22284.184105 $781314.2300 $35.0600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 214 280 248.857306 $12069.5800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 31 33 29.469711 $1664.7400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 3.477778 $68.5500 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 375 390 422.839661 $9932.5000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 24 28 17.083336 $236.9500 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 70 74 44.293083 $1049.7700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 25 31 20.511114 $186.2400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 29 34 23.411114 $651.5400 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 4 2.477778 $95.3200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 35 39 55.345239 $4695.5000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 8 10 17.870635 $912.6600 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 47 52 59.866670 $999.7800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 42 45 45.781747 $1025.5100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 36 39 26.049695 $1172.2400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 15 18 8.138432 $935.9000 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 27 30 40.742466 $2037.1300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 7 11 21.000000 $1050.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 350 354 590.556785 $29527.8500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 6 10.000000 $750.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 32 32 57.664384 $4324.8300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 25 26 50.005479 $3750.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 18.357143 $1376.7800 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $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 10 10 16.361643 $1227.1300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 17 18 34.500000 $2587.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 57 60 107.334247 $5957.0500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 15 15 28.356164 $1573.7700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 338 339 648.105020 $48607.8900 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 325 326 636.159295 $47711.9500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 131 132 263.000000 $19725.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 87 87 173.000000 $12975.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 32 32 61.000000 $4575.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 140 141 260.031506 $19502.3600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 566 571 1033.497576 $57359.1400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 174 174 336.151076 $18656.3900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 259 268 455.028564 $34127.1800 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 10.000000 $750.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 2 3.033333 $151.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 7 28.628570 $1431.4300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 91 101 51.019958 $2604.6100 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 6 6 1.700000 $86.7900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 17 20 26.755556 $1365.8700 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 2 2 0.483334 $24.6800 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 107 118 90.114247 $4600.3600 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.500000 $25.5300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 523 593 424.355936 $21663.5300 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.005556 $0.2900 $51.4600
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 1.505556 $76.8600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 57 62 24.599325 $1255.8500 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 4 4 1.300000 $66.3700 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 72 78 51.742316 $2641.4500 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.505556 $25.8100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 301 369 242.045430 $12356.5200 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.505556 $25.8100 $51.0500
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.505556 $25.8100 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 5 5 1.685693 $86.0600 $51.0500
SCREEN-T1023 SCREENING 63 68 67.777778 $3388.8900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.966667 $14.5000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 13 14 11.516666 $587.9200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 23 25 21.527093 $1098.9600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 595 675 394.459215 $20137.3600 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 16 17 7.900001 $403.3000 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 2.733335 $139.5500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 27 30 28.409057 $1450.2800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 70 75 71.413494 $3645.6700 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.505556 $25.8100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 77 86 77.959461 $3473.1000 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 6 4.313470 $192.1600 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.011111 $45.0400 $44.5500
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Subtotal (Total Children Is Unduplicated) 3610 6115 7534.809029 $438146.1500 $58.1500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 188 237 246.930042 $1234651.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 15 12.100001 $605.0100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 29 35 36.177776 $1808.8800 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.833333 $131.2800 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 45 47 90.769417 $6500.0000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 67 71 81.561115 $18759.1500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 739 991 1021.180536 $51059.2300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 82 104 81.516750 $4075.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 193 235 199.897181 $4997.4600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2298 2923 6032.487989 $301623.8600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 125 149 269.078563 $13453.9000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 277 340 429.760329 $10744.0400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1854 2399 4156.238353 $207811.5000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 152 176 243.594037 $12179.6600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 139 258 321.106352 $8027.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 829 1076 1856.000757 $92799.8900 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 97 112 183.060712 $9153.0300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 60 114 166.642852 $4166.0600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2585 3132 5059.556452 $252977.3000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 184 214 274.176974 $13708.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 293 349 449.740880 $11243.5400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.288889 $21.1800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 204 295 2658.500007 $66462.4900 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 2.466667 $123.3400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8616 11025 90765.080704 $4538254.3700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 939 1126 7637.812696 $381890.6000 $50.0000
INTR -T1013 INTERPRETER 201 249 1607.351511 $80367.6000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5087 8023 56898.427197 $568984.2700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1263 1591 11230.399184 $802299.7500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 49 59 333.642858 $23835.4600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 245 299 2451.541464 $140228.2100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 9 11 48.964285 $2800.7600 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 15 15 81.561903 $5826.7800 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 120 133 891.824607 $63711.9900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1081 1414 9812.915868 $701034.7500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 45 59 341.323811 $24384.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 85 106 913.214287 $52199.3400 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 3 33.285714 $1902.6100 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 17 18 59.186507 $4228.2800 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 97 129 701.250004 $50097.3300 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 7 4.214079 $273.9200 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 3 5 5.233333 $1193.1900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 3 3.011111 $686.5300 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 12 13 12.605556 $5748.1500 $456.0000
SENS -V5264 EARMOLD 34 44 41.005553 $738.1000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1783 2263 16151.559558 $1153867.5700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 59 71 429.142857 $30657.9900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 11 34.320635 $1963.1400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 39 42 307.850795 $21992.8500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 131 158 991.684123 $70845.9700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 67 76 592.513750 $8224.0900 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 6.066666 $84.2000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 6.500000 $240.5000 $37.0000
TRAV -TRAVS Travel by mile 1586 3001 229152.275485 $101972.7600 $0.4500
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Subtotal (Total Children Is Unduplicated) 11849 43232 455420.432065 $11167619.7900 $24.5200
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Total 50102 485239.425199 $12387080.1700 $25.5300
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Number of Children (Unduplicated) With at Least One Authorization 12695