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 25310 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 545 600 6859.422222 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 156.416667 $5787.4200 $37.0000
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Subtotal (Total Children Is Unduplicated) 548 606 7019.916667 $5938.3000 $0.8500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 207 257 219.384482 $10640.1300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 69 69 68.700000 $1613.7600 $23.4900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.000000 $16.7000 $16.7000
EVAL -96111 DEVELOPMENTAL EVALUATION 33 38 50.655860 $2532.8000 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 1 1 2.000000 $100.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 259 262 449.971410 $22498.5800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 4.005479 $300.4100 $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 2 2 4.000000 $222.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 6 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $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 7 7 14.000000 $777.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 3 4 8.000000 $600.0000 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 1.533333 $76.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 6 2.783333 $142.0900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 1.194444 $60.9700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 13 14 17.200467 $878.0900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 4 2.511111 $128.1900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.127778 $108.6200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 12 13 11.009525 $562.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 23 27 28.037301 $1431.3000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.511111 $67.3200 $44.5500
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Subtotal (Total Children Is Unduplicated) 629 738 932.625634 $45807.1700 $49.1200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 15 16 24.716667 $123583.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 3.577778 $178.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 11 11 10.311110 $515.5500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.243836 $17.4600 $71.6000
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 2.655555 $610.7700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 726 947 829.227910 $41461.4800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 90 114 72.854333 $3642.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 116 128 111.546918 $2788.6900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2271 2909 6276.321605 $313816.3900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 145 176 321.764288 $16088.2100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 266 331 385.322216 $9633.0400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1874 2476 4206.312687 $210315.4400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 170 192 257.846029 $12892.2700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 136 270 282.260310 $7056.4900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 802 1043 1868.667820 $93433.3500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 99 113 172.363488 $8618.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 62 122 150.205561 $3755.1500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2487 3047 5077.759153 $253888.0200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 224 258 315.007140 $15750.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 273 323 375.797615 $9394.9300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 9 12 68.142859 $1703.5700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 172 219 1853.849201 $92692.5600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 12 14 84.204762 $4210.2400 $50.0000
INTR -T1013 INTERPRETER 198 256 1381.477771 $69073.9100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5106 7788 56857.606077 $568576.7400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 37 46 295.311111 $21097.0400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 5.187301 $370.5800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 1 1 4.000000 $228.8000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 4.357143 $249.2300 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 9.000000 $642.9600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 23 26 214.290475 $15308.9200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 2 6.571429 $469.4600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 3 5 29.571428 $1690.3100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 4.466667 $290.3400 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.266667 $1033.6200 $456.0100
SENS -V5264 EARMOLD 2 2 1.655555 $29.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 42 52 350.503173 $25039.9800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 8 52.761905 $3769.3200 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 16.209524 $1158.0100 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 43.214286 $599.8100 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 0.666667 $24.6700 $37.0000
TRAV -TRAVS Travel by mile 1660 3033 236161.089108 $105091.6900 $0.4500
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Subtotal (Total Children Is Unduplicated) 8058 23966 318193.165128 $2041248.3700 $6.4200
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Total 25310 326145.707429 $2092993.8400 $6.4200
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Number of Children (Unduplicated) With at Least One Authorization 8616