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 25373 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 560 620 3472.079371 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 44.000000 $1628.0000 $37.0000
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Subtotal (Total Children Is Unduplicated) 565 625 3525.046037 $1959.7600 $0.5600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 203 274 237.120228 $11500.3300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.911111 $21.4100 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 4 3.577778 $84.0800 $23.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.422222 $33.4200 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.305555 $12.7800 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.911111 $26.1700 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.911111 $40.7800 $44.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.911111 $26.2000 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.911111 $19.0300 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.355556 $16.0000 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.355556 $40.8900 $115.0100
EVAL -96111 DEVELOPMENTAL EVALUATION 30 32 40.158446 $2007.9200 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 3 6.000000 $300.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 231 234 370.882518 $18544.1300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 8 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 9 9 16.142857 $895.9300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 5 8.142857 $610.7200 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.142857 $7.1500 $50.0200
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.716667 $35.8400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 4 5 2.711111 $138.4000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 1.411111 $72.0400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 32 34 34.412447 $1756.7500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 4 3.511111 $179.2400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 18 19 10.299999 $525.8100 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 33 33 21.215077 $1083.0200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 4 3.155556 $161.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 7.094445 $316.0600 $44.5500
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Subtotal (Total Children Is Unduplicated) 553 699 809.689509 $40836.0500 $50.4300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 23 27 55.342857 $276714.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 2.488889 $124.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 18 17.266667 $863.3400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.355556 $93.3500 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 2.511111 $577.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 791 1053 917.638900 $45882.0800 $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 144 158 110.972555 $2774.3400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2521 3199 6835.134024 $341757.1800 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 166 206 337.828568 $16891.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 225 284 382.545241 $9563.6400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1894 2429 4131.849221 $206592.4600 $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 857 1084 1969.744545 $98487.3300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 108 124 164.934925 $8246.7600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 48 99 119.666665 $2991.6600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2604 3105 5072.808360 $253640.6100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 236 275 353.288089 $17664.3700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 227 281 356.016670 $8900.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 8.678571 $216.9700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 215 252 2216.042845 $110802.2700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 7 7 56.174603 $2808.7300 $50.0000
INTR -T1013 INTERPRETER 183 210 1218.598101 $60929.9200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5052 7450 54821.116846 $548211.9300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 35 40 339.254758 $24236.4100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 3.590476 $256.5000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 4 4 28.785714 $1646.5400 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 0.642857 $36.7700 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 5 5 134.076190 $9578.4000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 41 47 313.030951 $22362.9500 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 4 10.176191 $726.9900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 3 19.714286 $1126.8700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 3.000000 $195.0000 $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 3.044444 $1388.2500 $455.9900
SENS -V5264 EARMOLD 2 2 1.511111 $27.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 54 59 416.292062 $29739.9400 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 5 6 13.685714 $977.7100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 2.533333 $180.9800 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 20.285715 $281.5700 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 1 1 6.571429 $243.1400 $37.0000
TRAV -TRAVS Travel by mile 1714 2973 245404.314332 $109204.9400 $0.4500
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Subtotal (Total Children Is Unduplicated) 8423 24049 326638.925326 $2248766.2900 $6.8800
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Total 25373 330973.660872 $2291562.1000 $6.9200
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Number of Children (Unduplicated) With at Least One Authorization 8981