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 41639 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 712 779 7834.362691 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 2.733333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 25 29 2631.678572 $97372.1000 $37.0000
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Subtotal (Total Children Is Unduplicated) 739 813 10472.852374 $97522.9800 $9.3100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 300 365 300.976825 $14597.3600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 12 12 12.216667 $690.1200 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 3 0.544445 $10.7300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 93 94 94.244445 $2213.8000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 9 5.588890 $77.5200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 10 9.694444 $229.7600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 13 15 7.529833 $68.3700 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 2.000000 $19.9200 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 11 13 6.277778 $174.7100 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $38.4700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 13 16 7.613774 $645.9500 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 5 5 4.252055 $217.1500 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 13 14 9.233333 $154.2000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 8 7.252055 $162.4500 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 10 4.652664 $209.3800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.305556 $35.1400 $115.0200
EVAL -96111 DEVELOPMENTAL EVALUATION 43 49 61.997108 $3099.8600 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 6.388889 $319.4500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 368 371 636.866941 $31843.3500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 8.944368 $670.8300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 6.427778 $482.0900 $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 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $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 22 22 38.683257 $2146.9200 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 2.005556 $111.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 67 68 129.010958 $9675.8300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 64 65 117.290410 $8796.7900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 20 20 42.166666 $3162.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 6 6 14.133333 $1060.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 46 46 81.295889 $6097.2000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 134 135 247.671231 $13745.7700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 58 58 102.032874 $5662.8300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 48 51 103.000000 $7725.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.466667 $23.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 4.000000 $200.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 11 13 6.400000 $326.7200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 20 11.985713 $611.8700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 96 106 80.067132 $4087.4200 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 7 3.983333 $203.3500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 2 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 6 3.283333 $167.6100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 53 57 49.274373 $2515.4500 $51.0500
SCREEN-T1023 SCREENING 8 8 8.000000 $400.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 4 4.000000 $60.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 4.194444 $214.1200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $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 116 136 97.484114 $4976.5600 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $153.1500 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $153.1500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 7 7 7.000000 $357.3500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 27 28 23.916667 $1065.4900 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.504110 $22.4600 $44.5500
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Subtotal (Total Children Is Unduplicated) 1415 1919 2422.941241 $132450.6800 $54.6700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 52 59 66.607523 $333038.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 5 5.855555 $292.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 32 40 73.862373 $3693.1300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 12 13 11.225266 $803.8400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 32 34 42.770634 $9837.2400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1069 1394 1241.204874 $62060.3800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 140 183 119.977316 $5998.8700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 173 189 142.507800 $3562.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3372 4303 9304.742290 $465237.6400 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 224 268 504.438097 $25221.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 373 463 518.546813 $12963.6400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2836 3723 6434.863900 $321742.9900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 261 290 395.566664 $19778.2900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 179 351 359.315865 $8982.8800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1162 1514 2762.419020 $138120.9300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 134 150 238.761105 $11938.0300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 79 158 194.216675 $4855.4400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3879 4783 8086.859192 $404343.0800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 335 380 514.235713 $25711.7500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 389 456 517.573004 $12939.3000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 37 43 252.035719 $6300.8900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 2.142857 $107.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2539 3224 26894.394298 $1344721.0600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 127 147 1081.880952 $54094.1000 $50.0000
INTR -T1013 INTERPRETER 225 289 1494.192057 $74709.6200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7149 10932 79940.522606 $799406.1800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 208 243 1709.942047 $122158.3600 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 17 18 129.655555 $9262.5900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 15 17 157.214286 $8992.6700 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 4.357143 $249.2300 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 2 3 23.619047 $1687.3500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 14 15 83.542063 $5968.2600 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 177 215 1743.211108 $124535.1200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 12 14 73.230158 $5231.5700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 9 11 85.428571 $4883.1000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 0.785714 $44.9100 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 1 26.285714 $1877.8500 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 6 6 39.149206 $2796.8300 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 9 8.466667 $550.3400 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 2.305556 $525.6800 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 3 2.022223 $461.0800 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 9 9 9.033333 $4119.1800 $456.0000
SENS -V5264 EARMOLD 17 24 19.612329 $353.0200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 437 529 3978.023001 $284190.2300 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 23 26 187.038095 $13362.0300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 9.714286 $555.6600 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 9.428571 $673.5800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 21 23 144.461905 $10320.3800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 22 23 164.873808 $2288.4500 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.000000 $180.4400 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 3.733334 $138.1400 $37.0000
TRAV -TRAVS Travel by mile 2382 4316 320015.657917 $142406.9800 $0.4500
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Subtotal (Total Children Is Unduplicated) 12634 38907 469844.509805 $4898275.3100 $10.4300
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Total 41639 482740.303420 $5128248.9700 $10.6200
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Number of Children (Unduplicated) With at Least One Authorization 13441