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 42625 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 729 801 4106.557939 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 18 18 1371.166664 $50733.1600 $37.0000
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Subtotal (Total Children Is Unduplicated) 750 823 5486.691269 $51064.9200 $9.3100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 292 390 309.347927 $15003.3700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 12 12 11.833333 $659.2300 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 3.683333 $86.5600 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 63 65 73.146825 $1718.9500 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 9 9 6.555555 $95.5800 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 12 12 9.233332 $216.9800 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 17 17 8.535387 $83.5600 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 3 3.000000 $29.3700 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 17 17 9.888888 $284.0100 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 2.055555 $92.0000 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 12 12 6.681887 $566.8900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 3.252055 $166.0800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 17 17 11.299999 $154.9200 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 9 15.448880 $322.7300 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 14 17.110460 $769.9800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 1.857763 $213.6500 $115.0000
BEHV -H2014BA Behavior Analysis - Technician 1 1 12.857143 $626.9100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 36 38 48.224199 $2411.2100 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 3 4 6.011111 $300.5600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 346 349 585.405535 $29270.2900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 10.233334 $767.5100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 8.188889 $614.1700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $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 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 2.016590 $151.2500 $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 21 23 42.122146 $2337.7800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 6.005479 $333.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 60 60 120.000000 $9000.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 45 45 82.060275 $6154.5200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 26 26 50.966667 $3822.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 8 8 14.566667 $1092.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 16.966667 $1272.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 29 29 48.358904 $3626.9000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 102 103 198.675733 $11026.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 48 48 80.436530 $4464.2100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 34 36 71.142857 $5335.7200 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $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 12 15 7.066666 $360.7500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 6 7 7.000000 $357.3500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 13 14 19.326191 $986.6100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 132 143 124.165359 $6338.6300 $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 4.888888 $249.5700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 10 7.088889 $361.8900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 66 83 56.411575 $2879.8000 $51.0500
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 2.244444 $33.6700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 9 9 9.411111 $480.4400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.400000 $71.4700 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.1000 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 0.711111 $36.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 113 124 88.429360 $4514.3000 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.194444 $112.0200 $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 26 28 25.877778 $1321.0600 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 34 37 47.474601 $2114.9800 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 0.432877 $19.2900 $44.5500
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Subtotal (Total Children Is Unduplicated) 1329 1900 2327.152723 $124962.7500 $53.7000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 62 73 92.867298 $464337.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 3.488889 $174.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 37 39 59.729834 $2986.5000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 15 15 14.778996 $1017.6800 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 35 37 37.165078 $8547.9500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1142 1509 1387.709518 $69385.6900 $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 205 221 159.526670 $3988.2100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3686 4699 9912.232854 $495612.1600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 234 287 540.138888 $27006.9100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 324 408 525.276983 $13131.9300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2884 3706 6347.392887 $317369.6100 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 306 342 531.171429 $26558.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 169 315 351.696027 $8792.3900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1233 1572 2846.577893 $142329.0700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 142 163 237.117463 $11855.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 62 134 163.116664 $4077.9100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4059 4895 8031.603226 $401580.3800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 347 407 565.452378 $28272.5900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 331 405 514.581751 $12864.5600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 14 14 108.255555 $2706.4000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3062 3852 33206.124483 $1660307.8700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 115 139 999.819839 $49991.0500 $50.0000
INTR -T1013 INTERPRETER 213 242 1382.369529 $69118.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7048 10446 76747.203054 $767473.0400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 252 302 2259.022215 $161384.7200 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 16 17 94.326982 $6738.7100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 32 34 285.642857 $16338.7900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 0.642857 $36.7700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 4 4 23.200001 $1657.4000 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 15 16 202.466666 $14464.2200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 229 284 2094.723808 $149647.1300 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 9 10 42.492064 $3035.6400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 20 25 182.785715 $10448.0300 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 2.285714 $130.6500 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 1 2 15.142857 $1081.8100 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 11 12 52.563492 $3755.1400 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 5 4.911111 $319.2200 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 2.076712 $473.4900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.955556 $445.8800 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 9 10 9.722221 $4433.2800 $455.9900
SENS -V5264 EARMOLD 18 20 17.875266 $321.7500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 549 652 4812.453956 $343802.0600 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 21 28 168.108730 $12009.6900 $71.4400
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 14.676190 $1048.4700 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 23 25 187.110315 $13367.1700 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 18 21 155.952380 $2164.6200 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 2 2 8.904762 $329.4700 $37.0000
TRAV -TRAVS Travel by mile 2443 4258 328977.974405 $146395.2300 $0.4500
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Subtotal (Total Children Is Unduplicated) 13323 39902 484583.381894 $5493364.4900 $11.3400
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Total 42625 492397.225886 $5669392.1600 $11.5100
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Number of Children (Unduplicated) With at Least One Authorization 14158