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
Eligibility Filter: Program Patients
With the filters selected there were 75044 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 4 4 17.946032 $664.0000 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 698 780 1553.886482 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 7.466667 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 200 230 26943.496030 $996909.3500 $37.0000
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Subtotal (Total Children Is Unduplicated) 900 1016 28522.795211 $997573.3500 $34.9700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 329 428 360.300004 $17474.5700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 46 49 45.664155 $2579.5700 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 17 17 15.061112 $296.8600 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 599 618 654.164396 $15366.3300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 64 71 65.527781 $908.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 123 128 91.781974 $2175.2600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 84 96 86.999322 $789.9600 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 8 8 9.000000 $89.6400 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 96 106 94.738896 $2636.6000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 23 24 27.700000 $1065.6200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 90 99 120.133444 $10192.1400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 32 35 45.119950 $2304.2800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 108 116 118.083341 $1972.0000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 106 112 137.840585 $3087.6300 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 73 79 54.666440 $2459.9900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 33 38 23.218189 $2670.0800 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 38 41 87.976593 $4398.8400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 7 11 21.000000 $1050.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 525 530 903.283966 $45164.2200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 9 16.000000 $1200.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 42 42 75.664384 $5674.8300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 30 31 58.010958 $4350.8300 $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 4 4 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 15 15 22.369862 $1677.7400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 22 23 43.500000 $3262.5000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 83 88 153.988128 $8546.3300 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 21 21 38.358904 $2128.9200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 512 514 985.177166 $73888.3100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 461 462 876.951464 $65771.3700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 201 202 400.819047 $30061.4300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 117 117 233.000000 $17475.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 61 61 124.533333 $9340.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 217 218 389.461642 $29209.6100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 886 893 1630.541275 $90495.0800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 246 246 473.962034 $26304.9000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 383 396 664.351781 $49826.4400 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 12 12 24.000000 $1800.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 3 6.066666 $303.3300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 10 37.128569 $1856.4200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 132 148 71.737420 $3662.2500 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 7 7 2.205556 $112.6000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 23 26 31.233334 $1594.4700 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 2 2 0.483334 $24.6800 $51.0600
OCTH -97166 OT EVAL MODERATE COMPLEXITY 161 175 149.995985 $7657.3400 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.500000 $25.5300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 825 937 649.758318 $33170.4300 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.005556 $0.2900 $51.4600
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 6 6 3.069103 $156.6800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 74 80 31.931975 $1630.1900 $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 4 4 3.505556 $178.9600 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 101 113 88.970095 $4541.9400 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 1.361111 $69.4800 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 2.428571 $123.9800 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 0.631583 $32.2400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 460 573 366.780242 $18724.2800 $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 6 6 2.685693 $137.1100 $51.0500
SCREEN-T1023 SCREENING 105 110 110.511111 $5525.5600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 7 8 26.895890 $403.4400 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 26 28 23.338204 $1191.4200 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 40 46 46.193759 $2358.1900 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1064 1234 739.907514 $37772.6700 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 23 25 12.544446 $640.4000 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 3.733335 $190.6000 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 39 42 32.996423 $1684.4700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 121 129 134.057938 $6843.6700 $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 131 145 120.836479 $5383.2800 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 7 4.631278 $206.3200 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.011111 $89.5900 $44.5500
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Subtotal (Total Children Is Unduplicated) 5687 9866 11926.260092 $677190.4500 $56.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 297 376 497.319842 $2486599.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 22 28 33.255556 $1662.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 75 93 243.945310 $12197.2500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 2.833333 $202.8900 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 56 58 102.791639 $7360.9100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 126 134 173.049710 $39801.5200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1093 1443 1547.016031 $77351.1100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 126 162 135.055412 $6752.7700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 316 387 343.335891 $8583.4500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3383 4283 8984.293452 $449213.8500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 197 231 438.788083 $21939.3600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 394 483 569.532553 $14238.3500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2806 3609 6300.394984 $315019.1700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 219 252 353.751179 $17687.5200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 185 333 415.784127 $10394.6000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1187 1544 2718.681688 $135933.8300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 126 146 236.674995 $11833.7300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 85 158 213.809517 $5345.2200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3979 4817 8007.799642 $400389.1300 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 282 329 461.388881 $23069.4100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 418 498 607.040882 $15176.0400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.288889 $21.1800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 294 440 4016.368263 $100409.2000 $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 12165 15618 127565.348078 $6378267.7300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1229 1475 9979.769839 $498988.4900 $50.0000
INTR -T1013 INTERPRETER 235 286 1736.494368 $86824.7400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7111 11234 79564.521602 $795645.2000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2023 2553 17981.693619 $1284612.2800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 103 125 687.123018 $49088.1000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 342 418 3403.372419 $194672.9500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 15 18 104.173810 $5958.7400 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 22 23 112.069046 $8006.2100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 152 174 1108.492068 $79190.7200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1714 2255 15644.028956 $1117609.5300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 85 108 626.314287 $44743.8700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 123 149 1212.323810 $69296.4500 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 7 58.071428 $3319.3600 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 25 29 146.688094 $10479.4000 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 127 165 994.524607 $71048.8900 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 11 12 10.346042 $672.4900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.249315 $28.4200 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 10 13 11.673135 $2661.4700 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 9 11 12.000000 $2736.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 30 32 32.077093 $14627.1600 $456.0000
SENS -V5264 EARMOLD 85 103 151.904789 $2734.2800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3589 4650 33199.505618 $2371772.9500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 154 179 1125.446824 $80402.0000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 11 14 63.677778 $3642.3700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 50 54 404.546033 $28900.7700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 188 225 1395.204757 $99673.4900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 115 134 992.099465 $13770.3400 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 11.923809 $165.5000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 7.166667 $265.1700 $37.0000
TRAV -TRAVS Travel by mile 2255 4284 298117.763557 $132662.4000 $0.4500
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Subtotal (Total Children Is Unduplicated) 17578 64162 632866.260457 $17613773.5300 $27.8300
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Total 75044 673315.315760 $19288537.3400 $28.6500
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Number of Children (Unduplicated) With at Least One Authorization 18788