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 25412 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 7.400000 $273.8000 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 527 582 1510.211309 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 530 586 1517.611309 $273.8000 $0.1800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 224 299 257.506110 $12489.0500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $55.7100 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 3.377778 $79.3800 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 6 6 5.377778 $126.3800 $23.5000
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.783334 $18.4100 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 0.877778 $8.5900 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.377778 $10.8500 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.377778 $16.9100 $44.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 2.377778 $32.6000 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 0.811111 $16.9400 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.500000 $22.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.500000 $172.5000 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 36 40 54.198858 $2709.9400 $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 -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 6 6 10.005479 $750.4100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 12.000000 $900.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 1.500000 $112.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 7 7 11.505479 $638.5600 $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 7 8 16.000000 $1200.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 3 1.000000 $51.0500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 2.444444 $124.7900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 32 32 32.477780 $1658.0000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 3 1.500000 $76.5800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 14 14 4.788890 $244.4800 $51.0500
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 3.433333 $175.2700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 25 26 11.538891 $589.0700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 4 4.000000 $204.2000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 6 18.653968 $831.0300 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.000000 $52.5700 $52.5700
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Subtotal (Total Children Is Unduplicated) 511 662 727.770890 $37108.0900 $50.9900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 22 31.916667 $159583.5000 $5000.0100
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 18 19 17.194444 $859.7200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.500000 $34.4300 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 6 6 3.961111 $911.0500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 866 1146 978.868818 $48943.6500 $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 154 161 108.804299 $2720.1200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2514 3249 6373.758728 $318687.9600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 170 200 389.834923 $19491.7400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 233 304 376.912703 $9422.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1898 2474 3955.515057 $197775.7600 $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 842 1101 1918.409582 $95920.4700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 94 106 150.141270 $7507.0700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 46 92 112.952777 $2823.8200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2589 3162 4856.799189 $242839.9500 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 236 262 328.668257 $16433.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 248 311 356.660321 $8916.5200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 157 223 1370.643647 $68532.1700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 156 179 1637.286510 $81864.3000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 9 10 52.530158 $2626.5100 $50.0000
INTR -T1013 INTERPRETER 182 214 989.074885 $49453.7400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4795 7090 49310.975230 $493109.2400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 55 64 507.452387 $36252.3700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 2 2 27.857143 $1593.4300 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 6.500000 $371.8000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 1.142857 $81.6500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 5 13.785714 $984.8500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 73 88 626.461903 $44754.4200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 2 3 22.285714 $1273.8600 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 5.000000 $357.2000 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 2.000000 $130.0000 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.800000 $364.8000 $456.0000
SENS -V5264 EARMOLD 2 3 1.400000 $25.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 68 81 553.280948 $39526.4100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.642857 $331.6900 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 25.714286 $356.9100 $13.8800
TRAV -TRAVS Travel by mile 1681 2930 232079.238904 $103275.2500 $0.4400
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Subtotal (Total Children Is Unduplicated) 8467 24164 307904.465732 $2085454.4200 $6.7700
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Total 25412 310149.847931 $2122836.3100 $6.8400
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Number of Children (Unduplicated) With at Least One Authorization 8952