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
Eligibility Filter: Program Patients
With the filters selected there were 78113 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 781 860 4511.923812 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 185 211 20305.795232 $751314.4000 $37.0000
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Subtotal (Total Children Is Unduplicated) 964 1075 24826.685710 $751646.1600 $30.2800
Screening, Eval, and Assessment, Class # 02
AACRS -92597GN AAC RE-EVAL BY LICENSED SLP 1 1 1.000000 $52.6300 $52.6300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 334 448 351.008962 $17023.9300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 65 70 66.251261 $3690.8500 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 36 37 37.216666 $874.5900 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1004 1041 1090.250693 $25620.8900 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 55 61 59.827777 $872.2900 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 169 177 155.748341 $3660.0700 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 77 86 80.461577 $787.7200 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 22 24 25.000000 $244.7500 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 98 107 101.365079 $2911.2100 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 36 39 43.099999 $1929.1500 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 66 68 62.600609 $5311.0400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 33 33 33.785388 $1725.4200 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 118 131 117.731744 $1614.1000 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 125 130 206.107610 $4305.5900 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 71 79 80.867625 $3639.0500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 31 39 22.274201 $2561.5200 $115.0000
BEHV -H2014BA Behavior Analysis - Technician 1 1 12.857143 $626.9100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 37 39 49.224199 $2461.2100 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 6.011111 $300.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 351 354 591.416646 $29570.8400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 39 39 69.016667 $5176.2500 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 16 16 24.211111 $1815.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 13 23.000000 $1725.0000 $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 10 10 20.000000 $1500.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 16 16 16.194976 $1214.6200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 13 24.500000 $1837.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 89 93 173.940010 $9653.6700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 22.235616 $1234.0800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 509 514 994.571227 $74592.8600 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 321 323 601.051971 $45078.8600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 196 196 389.180953 $29188.5800 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 62 63 121.709524 $9128.2200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 33 34 64.966667 $4872.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 178 181 320.607829 $24045.5600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 731 744 1429.977793 $79363.7800 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 231 232 420.295435 $23326.3700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 280 299 586.683756 $44001.2800 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 18.000000 $1350.0000 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.142857 $7.1500 $50.0200
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 3.138889 $156.9500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 12 14 42.554762 $2127.7400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 145 181 126.598333 $6462.8300 $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 23 26 22.844445 $1166.2100 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 1.511111 $77.1400 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 2 3 11.939682 $609.5200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 145 154 118.791184 $6064.3000 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 2 2 1.172222 $59.8400 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.005556 $0.2900 $51.4600
OCTH -97167 OT EVAL HIGH COMPLEXITY 892 1011 802.450315 $40965.0100 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 4.511111 $230.2900 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.666667 $34.0400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 81 97 48.927703 $2497.7600 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.0900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 3.511111 $179.2400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 103 114 80.385725 $4103.7000 $51.0500
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 4 4 13.714286 $700.1200 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 1.127778 $57.5700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 508 624 413.929600 $21131.1000 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.511111 $26.0900 $51.0500
SCREEN-T1023 SCREENING 96 97 96.411112 $4820.5600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 8 11 25.332704 $379.9900 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 41 43 43.311111 $2211.0300 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 43 47 47.446822 $2422.1400 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 2.142466 $109.3700 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 3 3 1.066667 $54.4600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1006 1171 748.579456 $38214.9200 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 21 24 12.974275 $662.3300 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 4.283333 $218.6600 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 33 34 21.921917 $1119.1100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 137 151 147.168255 $7512.9400 $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 257 283 244.905286 $10910.5000 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 6 3.684932 $164.1700 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 2.472222 $110.1400 $44.5500
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Subtotal (Total Children Is Unduplicated) 5928 9922 11627.040727 $625246.2400 $53.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 245 314 325.249793 $1626250.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 19 19 26.704763 $1335.2400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 111 136 183.188938 $9159.4700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.266667 $87.2300 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 74 78 147.975058 $10189.5600 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 161 170 192.045723 $44170.4900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1250 1666 1583.130307 $79156.7400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 191 244 200.967876 $10048.4200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 377 475 449.150179 $11228.7900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3735 4766 9983.924124 $499196.7200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 234 287 540.138888 $27006.9100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 336 421 536.704761 $13417.6200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2917 3744 6380.220665 $319011.0000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 306 342 531.171429 $26558.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 172 319 353.351582 $8833.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1253 1597 2876.377098 $143819.0200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 142 163 237.117463 $11855.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 67 142 176.427776 $4410.6900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4108 4954 8104.450850 $405222.7900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 347 407 565.452378 $28272.5900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 344 420 538.746036 $13468.6600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 378 468 6251.184124 $156279.7100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13266 17098 142999.989946 $7150007.0900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1260 1537 9679.802557 $483990.4300 $50.0000
INTR -T1013 INTERPRETER 236 270 1464.762386 $73238.1400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7052 10452 76805.488768 $768055.9000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2196 2755 20638.801577 $1474437.3400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 96 111 654.783330 $46777.7800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 404 494 4090.988091 $234004.7000 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 19 24 141.095239 $8070.6500 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 39 47 215.571430 $15400.4200 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 166 187 1227.241262 $87674.1800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1973 2575 18518.013508 $1322927.6700 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 68 87 479.780157 $34275.5500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 202 246 1966.955167 $112431.1500 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 10 12 74.883333 $4280.3400 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 34 41 171.807140 $12273.9000 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 118 149 782.411101 $55895.4900 $71.4400
PHY -97110TLHM PT SESSION BY PT ASST 1 1 6.428571 $367.4600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 8 8 7.108371 $462.0500 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 6 2.504109 $285.4700 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 7 8 3.242161 $739.2000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 15 18 16.956774 $3866.1700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 28 31 30.580364 $13944.5700 $456.0000
SENS -V5264 EARMOLD 91 120 148.605261 $2674.8900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3784 4839 36560.112621 $2611856.7800 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 123 143 874.107935 $62446.2600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 14 65.714287 $3758.8500 $57.2000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 5.285714 $302.3400 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 55 64 433.146028 $30943.9800 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 213 246 1699.426973 $121407.1500 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 111 130 867.742858 $12044.2800 $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 2 2 8.904762 $329.4700 $37.0000
TRAV -TRAVS Travel by mile 2444 4264 329039.688690 $146422.6900 $0.4500
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Subtotal (Total Children Is Unduplicated) 19165 67116 689883.581711 $18344804.0100 $26.5900
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Total 78113 726337.308148 $19721696.4100 $27.1500
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Number of Children (Unduplicated) With at Least One Authorization 20382