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
Eligibility Filter: Program Patients
With the filters selected there were 74982 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 766 839 8811.716662 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 2.733333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 219 245 26279.641265 $972346.7100 $37.0000
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Subtotal (Total Children Is Unduplicated) 981 1089 35098.169038 $972497.5900 $27.7100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 337 413 332.648209 $16133.4100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 57 59 64.143086 $3623.4500 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 21 22 19.633334 $386.9700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 449 452 458.074278 $10760.1700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 55 60 53.077778 $736.1900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 149 154 125.540375 $2975.3000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 76 87 77.456022 $703.3000 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 16 16 17.000000 $169.3200 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 92 101 85.382538 $2376.1900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 24 24 26.088889 $1003.6400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 81 91 91.996781 $7805.0100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 40 41 42.635389 $2177.3900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 107 118 97.848412 $1634.0700 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 117 122 176.655229 $3957.0800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 65 74 64.870277 $2919.1800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 25 27 22.161111 $2548.5300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 45 52 66.997108 $3349.8600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 5 7 8.411111 $420.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 375 378 645.428052 $32271.4100 $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 25 25 42.944368 $3220.8300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 31 31 57.433334 $4307.5100 $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 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 15 30.000000 $2250.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 20 21 37.509666 $2813.2300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 6 6 11.000000 $825.0000 $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 91 97 164.396499 $9124.0100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 21 21 35.515222 $1971.1000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 486 487 937.351462 $70301.3800 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 467 472 901.244072 $67593.3200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 164 164 328.666666 $24650.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 78 78 154.005479 $11550.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 44 45 89.133333 $6685.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 193 194 359.707238 $26978.0600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 845 848 1583.735024 $87897.3300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 284 286 534.828914 $29683.0200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 395 410 741.306850 $55598.0400 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 16.000000 $1200.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 4 3.777778 $188.8900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 12 37.152380 $1857.6300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 144 171 81.474279 $4159.2700 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 3 3 0.872222 $44.5300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 23 23 27.001587 $1378.4300 $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 166 182 142.600551 $7279.7500 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 825 977 654.144336 $33394.0700 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 3.094444 $157.9700 $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 69 84 33.779528 $1724.4400 $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 5 6 5.277778 $269.4300 $51.0500
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 2 3 3.000000 $153.1500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 98 108 76.507978 $3905.7200 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 14.142857 $722.0000 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.466667 $23.8300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 461 546 372.173693 $18999.4700 $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 3 3 1.694444 $86.5000 $51.0500
SCREEN-T1023 SCREENING 115 118 118.322222 $5916.1100 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 7 12 28.797390 $431.9600 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 33 33 31.538888 $1610.0600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 35 37 39.847272 $2034.2200 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.1000 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 2 1.083333 $55.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1042 1222 710.749126 $36283.7500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 18 18 12.813319 $654.1200 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 13 14 8.066666 $411.8000 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 40 40 28.779147 $1469.1800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 73 75 68.083334 $3475.6600 $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 170 184 170.002537 $7573.6300 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 3.646576 $162.4600 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.277778 $56.9300 $44.5500
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Subtotal (Total Children Is Unduplicated) 5417 9427 11217.951359 $639572.4200 $57.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 258 315 322.799999 $1614002.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 24 32 44.060316 $2203.0200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 80 98 171.482659 $8574.1400 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 3.066667 $219.6100 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 69 77 184.778027 $13231.9500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 125 143 159.043129 $36579.9400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1178 1536 1425.431814 $71271.7200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 141 184 120.977316 $6048.8700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 323 429 408.462320 $10211.5900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3417 4359 9365.939909 $468297.5200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 224 268 504.438097 $25221.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 379 472 528.607923 $13215.1700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2859 3753 6457.486120 $322874.0900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 261 290 395.566664 $19778.2900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 182 354 360.449198 $9011.2100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1177 1531 2784.194417 $139209.7000 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 134 150 238.761105 $11938.0300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 82 161 200.194453 $5004.8800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3919 4825 8142.620304 $407131.1400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 335 380 514.235713 $25711.7500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 398 467 543.976973 $13599.4000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 369 569 5168.604028 $129215.0700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 2.142857 $107.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12245 15761 130537.655190 $6526889.9900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1288 1572 10004.028523 $500201.7900 $50.0000
INTR -T1013 INTERPRETER 262 336 1595.158724 $79757.9600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7152 10935 79976.094034 $799761.8900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1962 2509 17492.292776 $1249650.6500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 104 120 829.466662 $59257.1300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 320 412 3229.053567 $184701.9900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 20 22 118.257143 $6764.3100 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 33 42 205.104763 $14652.7100 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 170 199 1162.890465 $83076.9900 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1611 2107 15092.531325 $1078211.2600 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 80 94 553.589685 $39548.4500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 135 176 1368.283329 $78211.1500 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 7 8 29.571428 $1690.3100 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 30 35 199.353967 $14241.8400 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 137 154 810.697613 $57916.2400 $71.4400
PHY -97110TLHM PT SESSION BY PT ASST 1 1 13.142857 $751.2500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 13 12.740944 $828.1700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 3 0.504110 $57.4800 $114.0200
SENS -V5050 IN EAR MONAURAL HEARING AID 10 10 11.089422 $2528.4100 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 11 14 14.718722 $3355.8600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 30 33 29.134855 $13285.5100 $456.0000
SENS -V5264 EARMOLD 84 107 143.330827 $2579.9500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3452 4448 32426.922657 $2316581.5100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 140 161 983.003177 $70225.8200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 9 40.428570 $2312.5100 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 2.642857 $151.1700 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 47 60 453.525394 $32399.8800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 217 245 1540.250790 $110035.6500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 140 162 1136.427767 $15773.6300 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 19.733333 $273.9000 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 3.733334 $138.1400 $37.0000
TRAV -TRAVS Travel by mile 2382 4317 320022.086488 $142409.8400 $0.4500
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Subtotal (Total Children Is Unduplicated) 17688 64466 658104.765306 $16840881.9200 $25.5900
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Total 74982 704420.885703 $18452951.9300 $26.2000
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Number of Children (Unduplicated) With at Least One Authorization 18841