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 25605 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 488 547 1070.326170 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 4 417.000000 $15429.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 494 554 1495.415059 $15728.2900 $10.5200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 209 273 244.499239 $11858.2200 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 213 215 225.170406 $5289.2500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.144444 $1.3100 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.144444 $4.0200 $27.8200
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 11.428571 $969.6000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.250000 $12.7700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.144444 $2.4100 $16.7000
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 347 351 586.556785 $29327.8500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 2.164384 $162.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 9.005479 $675.4100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 9 9 15.005479 $832.8100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 3.000000 $166.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 10.500000 $787.5000 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.833333 $41.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 1.527778 $77.9900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 2.505556 $127.9100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 21 22 18.950001 $967.4000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 1.166667 $59.5600 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 8 8 5.905555 $301.4800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 23 25 21.594445 $1102.4000 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.138889 $50.7400 $44.5500
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Subtotal (Total Children Is Unduplicated) 859 992 1251.378365 $57708.3700 $46.1200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 17 21 28.933333 $144666.5000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 3.377778 $168.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 12 13 12.722223 $636.1200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.249315 $17.8500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 1.544444 $355.2100 $229.9900
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 706 949 968.230611 $48411.7300 $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 122 132 94.425011 $2360.6500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2277 2899 6009.321323 $300465.5300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 125 149 269.078563 $13453.9000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 272 334 423.354774 $10583.9000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1845 2388 4148.907456 $207444.9600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 152 176 243.594037 $12179.6600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 138 257 320.600796 $8015.0300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 815 1061 1838.528533 $91926.2700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 97 112 183.060712 $9153.0300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 59 113 163.609519 $4090.2300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2566 3109 5043.648309 $252181.8900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 184 214 274.176974 $13708.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 286 342 443.001992 $11075.0700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.288889 $21.1800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 5 5 21.750000 $543.7500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 186 225 1810.514287 $90525.7100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 14 16 144.869049 $7243.4600 $50.0000
INTR -T1013 INTERPRETER 184 232 1576.484845 $78824.2700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5086 8022 56896.284340 $568962.8400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 49 58 315.379366 $22530.7100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 5.322222 $380.2200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 3 4 21.857143 $1250.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 34 39 255.490476 $18252.2300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 1 1 13.000000 $743.0800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.505556 $97.8600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 4.000000 $912.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 1.000000 $456.0000 $456.0000
SENS -V5264 EARMOLD 1 1 0.544444 $9.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 55 59 324.593653 $23188.9700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 5 25.500000 $1821.7200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 5.142857 $367.4100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 3.428571 $47.5900 $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) 7979 24059 311137.613636 $2053363.3200 $6.6000
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Total 25605 313884.407060 $2126799.9800 $6.7800
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Number of Children (Unduplicated) With at Least One Authorization 8674