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: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 51823 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 8.966666 $331.7600 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 585 648 3659.519847 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 129 148 13749.831743 $508743.7600 $37.0000
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Subtotal (Total Children Is Unduplicated) 715 800 17418.318256 $509075.5200 $29.2300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 209 283 243.627839 $11815.9500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 41 44 39.906817 $2223.2100 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 13 13 12.911111 $303.4100 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 647 668 677.507043 $15921.4100 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 21 22 14.711110 $214.4900 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 105 108 97.270564 $2285.8500 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 24 25 15.066665 $147.5000 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 8 8 8.000000 $78.3200 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 34 35 27.866666 $800.3300 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 10 10 9.911111 $443.6200 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 22 22 19.077778 $1618.5600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 10 10 10.022222 $511.8300 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 54 61 51.599999 $707.4300 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 54 54 109.492063 $2287.2900 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 27 29 30.517134 $1373.2700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 15 19 12.071993 $1388.2800 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 31 33 41.158446 $2057.9200 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 3 6.000000 $300.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 232 235 372.882518 $18644.1300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 25 25 44.783333 $3358.7500 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 10 10 16.022222 $1201.6700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 7 7 12.000000 $900.0000 $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 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 12 12 14.172907 $1062.9600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 8 15.500000 $1162.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 56 57 109.815124 $6094.7400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 10 10 16.230137 $900.7700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 333 338 650.571227 $48792.8600 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 218 220 408.969474 $30672.6800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 120 120 237.714286 $17828.5700 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 39 40 77.142857 $5785.7200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 16 17 30.000000 $2250.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 124 127 226.248925 $16968.6500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 490 500 956.444917 $53082.7100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 160 160 293.858905 $16309.1600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 193 204 396.222309 $29716.6700 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 6 6 12.000000 $900.0000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.142857 $7.1500 $50.0200
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.066667 $153.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 10 33.721428 $1686.0700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 97 121 95.317132 $4865.9300 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 4 4 2.444444 $124.7900 $51.0500
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 1 1 0.188889 $9.6400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 11 13 9.844445 $502.5600 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 2 3 11.939682 $609.5200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 90 96 65.465223 $3342.0100 $51.0500
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.005556 $0.2900 $51.4600
OCTH -97167 OT EVAL HIGH COMPLEXITY 568 648 520.955356 $26594.7200 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.666667 $34.0400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 61 77 37.090946 $1893.5000 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.0900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 61 66 46.511904 $2374.4400 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 1.127778 $57.5700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 317 390 248.983706 $12710.6400 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
SCREEN-T1023 SCREENING 70 71 70.411112 $3520.5600 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 26 28 27.900000 $1424.3000 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 22 24 22.349999 $1140.9600 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.355556 $18.1500 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 559 638 411.415051 $21002.7100 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 13 15 7.557610 $385.8200 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 6 6 3.283333 $167.6100 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 19 19 11.456849 $584.8700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 69 77 71.055556 $3627.3900 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.511111 $26.0900 $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 147 160 132.641637 $5909.1700 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 4 3.252055 $144.8800 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.472222 $21.0400 $44.5500
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Subtotal (Total Children Is Unduplicated) 3738 6040 7176.965806 $394287.6500 $54.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 150 195 208.352043 $1041760.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 8 8 7.588890 $379.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 47 56 64.311113 $3215.5700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.266667 $87.2300 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 58 62 131.551618 $9058.6400 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 83 86 113.033004 $25997.5700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 849 1136 1019.476585 $50973.9800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 133 161 129.913538 $6495.7000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 237 294 254.647292 $6366.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2554 3245 6880.438784 $344022.4100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 166 206 337.828568 $16891.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 234 293 390.284130 $9757.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1908 2448 4147.693665 $207384.6800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 206 227 360.269051 $18013.4600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 124 236 274.229365 $6855.7300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 869 1098 1990.499306 $99525.0600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 108 124 164.934925 $8246.7600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 50 102 124.199999 $3105.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2632 3140 5117.580585 $255879.2400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 236 275 353.288089 $17664.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 236 291 373.530955 $9338.2800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 289 356 4445.321422 $111133.1200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9355 11981 100783.477383 $5039179.4000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 993 1212 7477.069237 $373853.6700 $50.0000
INTR -T1013 INTERPRETER 199 228 1271.848101 $63592.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5054 7454 54863.259703 $548633.3600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1373 1698 13008.311109 $929314.5900 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 48 54 343.857936 $24565.2400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 283 343 2911.921425 $166562.0500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 14 18 90.523809 $5177.9700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 28 34 149.400000 $10673.1400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 129 145 938.593643 $67053.1700 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1263 1630 11787.029779 $842065.8900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 38 52 275.701587 $19696.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 137 166 1380.709526 $78921.3700 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 8 10 66.026190 $3774.0600 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 28 33 106.588093 $7614.6500 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 82 106 550.876180 $39354.6100 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 4.197260 $272.8200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 2 2.000000 $228.0000 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 2.765449 $630.5300 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 4 6 5.460274 $1244.9500 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 12 12 12.844444 $5857.0500 $456.0000
SENS -V5264 EARMOLD 36 47 45.802891 $824.4500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1893 2359 18224.118999 $1301932.2100 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 51 58 339.677778 $24266.5700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 9 10 48.000001 $2745.5900 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 41 47 332.765076 $23772.7500 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 140 163 1090.442058 $77901.2100 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 71 83 541.590479 $7517.2800 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 2 3 16.704762 $231.8600 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 6.571429 $243.1400 $37.0000
TRAV -TRAVS Travel by mile 1715 2979 245466.028617 $109232.4000 $0.4500
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Subtotal (Total Children Is Unduplicated) 12902 44983 489034.402812 $12029083.5300 $24.6000
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Total 51823 513629.686874 $12932446.7000 $25.1800
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Number of Children (Unduplicated) With at Least One Authorization 13784