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: 01-01-22 and 03-31-22 Date of Report: 04-16-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 52120 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 5 5 16.400000 $606.8000 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 552 610 1739.148609 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 96 106 10198.338890 $377338.5400 $37.0000
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Subtotal (Total Children Is Unduplicated) 652 721 11953.887499 $377945.3400 $31.6200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 229 306 262.502914 $12731.3900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 38 39 42.705306 $2379.1200 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 111 115 119.808730 $2815.5000 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 648 682 709.188889 $16665.9400 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 19 19 16.533105 $241.0500 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 138 144 94.962094 $2231.6200 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 27 29 18.666666 $182.7500 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 12 12 12.000000 $117.4800 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 37 39 30.944444 $888.7200 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 14 14 13.377778 $598.7900 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 9 7.127778 $604.7200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 3.155556 $161.1600 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 66 72 64.050000 $878.1300 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 55 56 89.395237 $1867.4600 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 22 24 19.827778 $892.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 22 23 22.591019 $2597.9700 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 37 42 57.198858 $2859.9400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 9 10 18.355556 $917.7800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 149 150 229.500989 $11475.0500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 23 24 43.694444 $3277.0800 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 18 18 29.033333 $2177.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 15 15 29.000000 $2175.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 15 15 23.027701 $1727.0800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 35 37 62.842455 $3487.7500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 10 10 16.230289 $900.7800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 294 298 577.203126 $43290.2500 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 248 248 466.243837 $34968.2700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 140 140 272.500000 $20437.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 36 37 72.000000 $5400.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 30 30 50.126027 $3759.4500 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 119 119 206.519179 $15488.9300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 508 513 981.903127 $54495.6300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 166 166 302.278083 $16776.4200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 218 234 450.931311 $33819.8500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 19 19 36.500000 $2737.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.633333 $81.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 9 30.909524 $1545.4800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 118 134 68.563243 $3500.1600 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 4 4 1.600000 $81.6800 $51.0500
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.0500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 64 70 51.386682 $2623.2900 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.288889 $14.7500 $51.0500
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 2 2 13.357143 $681.8800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 74 82 48.793531 $2490.9100 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 1.138888 $58.1400 $51.0500
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 565 637 488.109707 $24918.0200 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 4.209524 $214.9000 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.500000 $25.5300 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 5 5 5.259524 $268.5000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 66 76 40.318796 $2058.2700 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.500000 $25.5300 $51.0500
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.422222 $21.5500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 23 28 16.455935 $840.0700 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 1.322222 $67.5000 $51.0500
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 52 56 45.620004 $2328.9000 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 1.500000 $76.5800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 279 327 178.740694 $9124.7300 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 1.366667 $69.7700 $51.0500
SCREEN-T1023 SCREENING 55 60 67.789682 $3389.4900 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 77 84 72.556347 $3703.9900 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 14 14 13.400000 $684.0700 $51.0500
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.038889 $1.9900 $51.0600
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 22 23 24.533333 $1252.4300 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.500000 $25.5300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 528 618 374.481905 $19117.3000 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 11 12 4.002131 $204.3100 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 1.900000 $97.0000 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 14 16 6.955632 $355.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 83 92 79.850000 $4076.3400 $51.0500
SPCH -92524GT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.155556 $7.9400 $51.0600
SPCH -92524TLGT BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 150 169 154.145738 $6867.1900 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.109589 $49.4300 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.500000 $22.2800 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 0.460578 $20.5200 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 21 22 121.060314 $6364.1500 $52.5700
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Subtotal (Total Children Is Unduplicated) 3789 6307 7416.522942 $406148.1700 $54.7600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 163 202 219.397671 $1096988.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 0.533333 $26.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 52 63 91.519841 $4575.9900 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 7.903175 $544.2100 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 40 45 87.464788 $6022.8200 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 93 99 110.956099 $25519.8600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 934 1234 1059.299730 $52965.2200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 127 158 109.419838 $5470.9900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 236 272 225.527361 $5638.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2545 3287 6409.934125 $320496.7300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 170 200 389.834923 $19491.7400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 239 310 382.912703 $9572.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1917 2497 3982.003946 $199100.2000 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 194 227 269.631749 $13481.6000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 134 261 325.442856 $8136.0700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 853 1113 1936.607202 $96830.3600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 94 106 150.141270 $7507.0700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 48 94 117.152777 $2928.8200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2614 3191 4887.572204 $244378.6000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 236 262 328.668257 $16433.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 253 316 371.795242 $9294.8900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 6 6 36.285713 $907.1500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 250 301 3577.000004 $89424.9600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 164 231 1380.000789 $69000.0300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9201 11971 97556.724308 $4877832.0000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1006 1199 6607.667750 $330383.1400 $50.0000
INTR -T1013 INTERPRETER 202 242 1065.789171 $53289.4500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4796 7093 49335.832373 $493357.8100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1360 1766 12880.015865 $920147.8500 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 35 39 211.695238 $15123.5000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 260 324 2792.330962 $159721.1900 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 12 16 81.952382 $4687.6700 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 39 48 171.275396 $12235.9400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 104 140 675.693651 $48271.5800 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1254 1675 11517.642041 $822819.9400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 27 30 163.676188 $11693.0400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 142 174 1389.840480 $79443.2000 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 10 10 79.819047 $4562.4500 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 50 60 229.282538 $16379.9600 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 87 102 551.438095 $39394.6700 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 2.000000 $130.0000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.246575 $56.2200 $228.0200
SENS -V5060 BEHIND EAR HEARING AID 4 4 4.000000 $912.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 11 11 7.855556 $3582.1500 $456.0000
SENS -V5264 EARMOLD 36 42 56.446575 $1016.0400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1863 2399 17285.340852 $1234864.2500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 40 48 268.809518 $19203.7700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 9 9 51.428571 $2941.7200 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 49 56 389.814288 $27848.3000 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 117 137 813.605559 $58123.9600 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 69 77 668.509520 $9278.9000 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 3 3 13.609524 $188.9000 $13.8800
TRAV -TRAVS Travel by mile 1682 2935 232141.524619 $103302.9600 $0.4400
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Subtotal (Total Children Is Unduplicated) 12645 45092 463471.872238 $11655642.9500 $25.1500
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Total 52120 482842.282679 $12439736.4600 $25.7600
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Number of Children (Unduplicated) With at Least One Authorization 13435