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: 07-01-21 and 09-30-21 Date of Report: 10-13-21 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 49659 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 4.077778 $150.8800 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 570 629 7694.898415 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 156 171 18640.249202 $689689.2100 $37.0000
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Subtotal (Total Children Is Unduplicated) 722 804 26339.225395 $689840.0900 $26.1900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 211 262 223.636537 $10846.3600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 35 37 41.504197 $2344.5800 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 7 7.000000 $137.9700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 269 270 274.835388 $6455.8800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 21 21 14.699999 $203.8900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 91 93 73.468154 $1741.1900 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 23 24 16.205555 $147.1500 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 5 5 5.000000 $49.8000 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 28 29 21.227777 $590.7700 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 6 6.000000 $230.8200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 31 33 35.655555 $3025.0100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 14 14 13.877778 $708.7400 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 45 51 41.361111 $690.7300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 46 47 75.256349 $1685.7400 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 29 30 32.175985 $1447.9300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 13 10.601826 $1219.2100 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 34 39 52.655860 $2632.8000 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 1 1 2.000000 $100.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 260 263 450.971410 $22548.5800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 4 5.000000 $375.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 19 19 34.005479 $2550.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 20 20 40.000000 $3000.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 14.857143 $1114.2800 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 12 13 26.000000 $1950.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 14 15 28.504110 $2137.8100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 7.500000 $562.5000 $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 60 63 108.043379 $5996.4000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 17 17 30.509666 $1693.2900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 307 308 587.335025 $44050.1400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 294 297 571.675884 $42875.7000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 101 101 200.500000 $15037.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 47 47 92.005479 $6900.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 28 28 55.000000 $4125.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 117 118 222.411349 $16680.8600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 528 530 975.987081 $54167.3000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 189 191 361.296040 $20051.9400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 252 261 463.652056 $34773.9200 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 6 6 12.000000 $900.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 2 3.066667 $153.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 9 32.719046 $1635.9600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 99 119 55.524280 $2834.5300 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 2 2 0.755555 $38.5700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 14 14 17.868254 $912.1700 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 111 118 97.761194 $4990.6900 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 519 615 419.065822 $21393.3100 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 0.183333 $9.3600 $51.0400
PSTF -97164 PT RE-EVAL EST PLAN CARE 55 67 27.996500 $1429.2300 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.111111 $5.6700 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.077778 $3.9700 $51.0600
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 1.277778 $65.2300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 67 70 45.839726 $2340.1200 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.466667 $23.8300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 294 348 249.533658 $12738.7200 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.477778 $24.3900 $51.0500
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.227778 $11.6300 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 0.694444 $35.4500 $51.0500
SCREEN-T1023 SCREENING 75 76 75.188889 $3759.4500 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 18 18 16.905555 $863.0300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 19 20 15.737748 $803.4200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 579 665 400.647434 $20453.0700 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 9 9 6.207763 $316.9100 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 12 13 7.066666 $360.7500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 29 29 21.707686 $1108.1700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 38 39 33.083334 $1688.9100 $51.0500
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 94 99 116.036859 $5169.4500 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 3.142466 $140.0000 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.277778 $12.3800 $44.5500
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Subtotal (Total Children Is Unduplicated) 3362 5652 6894.087941 $399678.7300 $57.9700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 157 191 187.821136 $939107.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 11 17.422222 $871.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 28 30 42.777776 $2138.8800 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 3.066667 $219.6100 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 51 58 168.074375 $12035.8100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 66 76 86.069755 $19796.0300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 788 1031 933.188413 $46659.5000 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 91 115 73.854333 $3692.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 201 259 241.982030 $6049.5700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2297 2942 6310.508114 $315525.7200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 145 176 321.764288 $16088.2100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 269 336 391.566660 $9789.1500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1881 2485 4212.523798 $210625.9900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 170 192 257.846029 $12892.2700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 137 271 282.688088 $7067.1800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 813 1055 1887.687662 $94384.3500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 99 113 172.363488 $8618.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 64 124 155.672228 $3891.8200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2510 3072 5111.720266 $255586.0900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 224 258 315.007140 $15750.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 280 331 398.090473 $9952.2600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 261 398 3479.076235 $86976.8900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8582 11025 91724.372085 $4586223.7600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 997 1228 7632.592819 $381629.9100 $50.0000
INTR -T1013 INTERPRETER 225 291 1447.230152 $72361.5300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5107 7789 56870.748934 $568708.1700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1209 1530 10836.076149 $774130.0500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 51 62 422.460315 $30180.5900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 231 291 2326.527373 $133077.4900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 13 15 68.147618 $3898.0400 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 25 30 139.528574 $9967.9400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 129 154 891.715073 $63704.1800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1006 1310 9515.933716 $679818.8900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 43 49 323.880955 $23138.0700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 95 126 972.357140 $55580.0000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 3 18.142857 $1037.0500 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 22 26 106.277777 $7592.4800 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 105 115 562.367454 $40175.5100 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 7 5.740944 $373.1700 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 5.274277 $1202.5400 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 4 2.566058 $585.0500 $227.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 12 13 10.933334 $4985.6300 $456.0000
SENS -V5264 EARMOLD 30 35 42.011716 $756.2100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1697 2138 15790.905268 $1128103.1500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 62 72 460.382542 $32889.7500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 6 18.428570 $1054.1100 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 36 46 353.763490 $25272.8700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 147 168 1063.436504 $75971.9800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 88 104 741.377770 $10290.3300 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 6.733333 $93.4600 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.666667 $24.6700 $37.0000
TRAV -TRAVS Travel by mile 1660 3034 236167.517679 $105094.5600 $0.4500
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Subtotal (Total Children Is Unduplicated) 11858 43203 463578.868319 $10895639.7300 $23.5000
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Total 49659 496812.181655 $11985158.5600 $24.1200
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Number of Children (Unduplicated) With at Least One Authorization 12674