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 41730 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 650 727 1352.949183 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.466667 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 17 21 3230.188888 $119516.9900 $37.0000
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Subtotal (Total Children Is Unduplicated) 672 753 4602.550770 $120180.9900 $26.1100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 299 389 333.324964 $16166.2700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 6 6 6.000000 $338.9400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 2.233334 $44.0200 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 241 243 254.403740 $5975.9500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 12 12 10.088889 $139.9300 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 10 10 7.877778 $186.7000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 15 17 9.349315 $84.8900 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 14 15 8.100000 $225.4200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 4.222222 $162.4300 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 16 18 24.894554 $2112.0700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 7 8 5.499315 $280.8500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 12 13 7.244445 $120.9800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 11 7.749315 $173.5800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 9 4.460427 $200.7200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 4.505556 $518.1400 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 35 38 82.976593 $4148.8400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 7 11 21.000000 $1050.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 511 516 881.783966 $44089.2200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 12.164384 $912.3300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 4 4 6.005479 $450.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 18 18 31.123744 $1727.3700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 55 55 103.572146 $7767.9200 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 44 44 69.646572 $5223.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 27 27 51.819047 $3886.4300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 35.533333 $2665.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 50 50 85.427396 $6407.0600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 147 147 264.982511 $14706.5400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 45 45 83.810958 $4651.5100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 38 39 76.510958 $5738.3300 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.033333 $151.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 3.866666 $193.3300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 12 12 6.178572 $315.4200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 13 14 12.848403 $655.9200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 101 107 75.097878 $3833.7900 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.024658 $1.2600 $51.1400
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 7 4.894445 $249.8600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 8 4.755555 $242.7700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 55 64 46.477096 $2372.6700 $51.0500
SCREEN-T1023 SCREENING 11 11 12.000000 $600.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 4 4.000000 $204.2000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 4.000000 $204.2000 $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 126 145 87.215803 $4452.4000 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 2.000000 $102.1000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 16 16 16.522222 $843.4600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 21 21 19.238889 $857.0900 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.317808 $14.1600 $44.5500
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Subtotal (Total Children Is Unduplicated) 1680 2218 2830.787748 $147442.4500 $52.0900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 63 76 180.425722 $902128.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 3.377778 $168.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 29 32 38.199314 $1909.9600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 7 7 6.249315 $447.5100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 29 30 50.961112 $11721.0800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1012 1344 1406.722531 $70336.4300 $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 187 204 146.492878 $3662.3800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3340 4233 8933.721233 $446685.2600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 197 231 438.788083 $21939.3600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 387 474 560.271442 $14006.8200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2777 3574 6273.473294 $313673.0800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 219 252 353.751179 $17687.5200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 183 331 414.995238 $10374.8800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1165 1520 2693.654700 $134682.4600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 126 146 236.674995 $11833.7300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 82 155 209.226184 $5230.6400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3938 4767 7967.597055 $398379.0000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 282 329 461.388881 $23069.4100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 408 487 592.429771 $14810.7700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.288889 $21.1800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 19 19 77.178570 $1929.4700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2481 3138 25626.112228 $1281305.5600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 141 161 1153.707935 $57685.4100 $50.0000
INTR -T1013 INTERPRETER 212 261 1662.841988 $83142.1300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7109 11231 79543.235888 $795432.3400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 228 271 1869.956349 $133589.7000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 16 18 91.398412 $6529.4900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 19 23 195.857144 $11203.0300 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 2 2 6.342857 $453.1400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 11 12 83.627778 $5974.3800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 206 250 1829.117060 $130672.1400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 8 9 33.311904 $2379.8000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 6 6 43.859524 $2507.0100 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 6.500000 $371.5400 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 16.292064 $1163.9100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 6 6 58.226983 $4159.7400 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 2.505556 $162.8600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 3 4.505556 $1027.2800 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 3 2.244444 $511.7200 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 9 9 9.011111 $4109.0600 $456.0000
SENS -V5264 EARMOLD 16 16 21.111110 $380.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 505 604 4259.792861 $304319.6500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 27 32 233.957143 $16713.9200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 13.000000 $743.6000 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 4 4 34.071428 $2434.0600 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 14 15 60.720633 $4337.8900 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 13 15 117.352381 $1628.8500 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.857143 $81.3000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 7.166667 $265.1700 $37.0000
TRAV -TRAVS Travel by mile 2255 4283 298108.763557 $132658.4000 $0.4500
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Subtotal (Total Children Is Unduplicated) 12436 38759 446281.371280 $5397393.6000 $12.0900
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Total 41730 453714.709798 $5665017.0400 $12.4900
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Number of Children (Unduplicated) With at Least One Authorization 13418