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
Eligibility Filter: Program Patients
With the filters selected there were 78838 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 760 835 2261.362100 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 143 158 13454.124604 $497802.6100 $37.0000
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Subtotal (Total Children Is Unduplicated) 906 998 15731.886704 $498409.4100 $31.6800
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 359 481 379.807992 $18420.7000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 70 74 70.805307 $3944.5700 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 183 195 202.958730 $4769.5300 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 967 1013 1067.138889 $25077.7600 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 52 55 53.449771 $779.3000 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 206 215 156.233067 $3671.4900 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 82 91 75.370633 $737.8800 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 26 26 26.000000 $254.5400 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 101 111 89.981745 $2584.2700 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 41 42 42.300001 $1893.3500 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 23 23 18.856316 $1599.7700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 10 10 8.166667 $417.0700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 128 142 120.015079 $1645.4100 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 120 129 163.084049 $3406.8200 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 64 73 65.648239 $2954.1700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 49 51 43.321156 $4981.9600 $115.0000
BEHV -H2014BA Behavior Analysis - Technician 1 1 25.714286 $1253.8300 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 54 64 81.809969 $4090.5000 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 12 14 26.355556 $1317.7800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 219 221 338.836704 $16941.8400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 34 36 65.694444 $4927.0800 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 21 21 34.033333 $2552.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 20 20 38.000000 $2850.0000 $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 17 17 26.027701 $1952.0800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 9 18.000000 $1350.0000 $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 58 62 110.076941 $6109.2700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 23.230289 $1289.2800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 445 449 865.719563 $64928.9900 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 387 387 730.587064 $54794.0200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 220 221 433.000000 $32475.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 52 53 100.000000 $7500.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 57 57 101.128767 $7584.6500 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 184 184 322.909981 $24218.2400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 773 779 1495.922304 $83023.6900 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 284 285 517.534247 $28723.1400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 336 363 701.431311 $52607.3500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 39 39 75.500000 $5662.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.633333 $81.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 14 42.309524 $2115.4800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 180 205 128.962993 $6583.5800 $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 2 2 2.000000 $102.1000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 119 133 109.594978 $5594.8200 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 5 1.288889 $65.8000 $51.0500
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.161111 $8.2200 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 3 3 14.357143 $732.9300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 130 143 89.080832 $4547.5700 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 2.138888 $109.1900 $51.0500
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.061111 $3.1200 $51.0400
OCTH -97167 OT EVAL HIGH COMPLEXITY 862 971 767.130462 $39162.0400 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 9 9 8.570636 $437.5400 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 2.500000 $127.6300 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 6 6 5.553968 $283.5300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 99 112 60.982039 $3113.1400 $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 48 60 33.283714 $1699.1300 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 3 1.344444 $68.6300 $51.0500
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 92 104 76.075558 $3883.6500 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 1.500000 $76.5800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 455 540 392.201187 $20021.8900 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 1.366667 $69.7700 $51.0500
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
SCREEN-T1023 SCREENING 85 90 97.789682 $4889.4900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 8 11 26.491193 $397.3700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 133 146 140.323013 $7163.4700 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 16 16 14.683333 $749.5800 $51.0500
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 0.172222 $8.7900 $51.0400
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 38 39 36.644673 $1870.7100 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 2 2.084932 $106.4300 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 1.022222 $52.1800 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 3 3 1.283333 $65.5100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 948 1133 725.260368 $37024.5500 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 19 21 10.657687 $544.0800 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 4.277778 $218.3800 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 19 21 10.089879 $515.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 150 166 173.214286 $8842.5900 $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 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 293 334 328.046532 $14614.4700 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.109589 $49.4300 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 3.500000 $155.9300 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 0.460578 $20.5200 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 49 52 248.003170 $13037.5400 $52.5700
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Subtotal (Total Children Is Unduplicated) 6042 10440 12329.539826 $665754.2900 $54.0000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 269 336 322.570043 $1612852.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 8 8 11.588888 $579.4400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 110 137 202.293163 $10114.6700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 7.903175 $544.2100 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 57 66 114.763288 $7902.5900 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 159 173 178.906599 $41148.4700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1383 1822 1661.884316 $83094.5300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 183 243 167.691879 $8384.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 414 502 442.410303 $11060.3000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3739 4832 9334.091059 $466704.5500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 237 289 573.324606 $28666.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 346 443 525.542864 $13138.5900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2912 3784 6076.697183 $303834.8600 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 279 327 395.369843 $19768.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 181 342 421.792857 $10544.8200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1244 1620 2893.634184 $144681.7100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 127 144 202.214286 $10110.7300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 65 126 164.347220 $4108.6800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4102 5028 7707.142422 $385357.0900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 348 393 497.065876 $24853.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 371 459 556.815085 $13920.3900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 9 9 58.857141 $1471.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 336 402 4901.785719 $122544.5800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 276 381 2157.015071 $107850.7500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 12.857142 $642.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13075 17120 138331.614823 $6916574.8500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1275 1511 8540.972515 $427048.3200 $50.0000
INTR -T1013 INTERPRETER 238 286 1217.220125 $60861.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6653 9891 68823.122074 $688230.5100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2186 2859 20495.764281 $1464216.6400 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 74 88 385.623805 $27548.9200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 378 480 3986.050008 $228001.9200 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 17 21 108.166668 $6187.1200 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 50 60 276.645238 $19763.5500 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 134 171 874.196827 $62452.6200 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 2010 2714 18631.682123 $1331046.6900 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 55 65 347.104759 $24797.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 209 260 1999.511908 $114291.9900 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 13 14 107.604761 $6150.6800 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 55 66 290.511110 $20754.1300 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 118 140 788.930952 $56361.1300 $71.4400
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 4.857143 $277.6300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 4.000000 $260.0000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.493150 $170.2200 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 0.750684 $171.1800 $228.0400
SENS -V5060 BEHIND EAR HEARING AID 11 13 11.739727 $2676.6700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 24 26 21.244445 $9687.4900 $456.0000
SENS -V5264 EARMOLD 90 112 149.371602 $2688.6900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3711 4848 35099.461492 $2507504.0500 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 110 133 676.210311 $48308.4500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 15 16 94.999999 $5434.0000 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 66 74 488.895239 $34926.6400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 188 228 1369.702387 $97851.4700 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 99 113 1025.828570 $14238.4900 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 4 4 15.038095 $208.7300 $13.8800
TRAV -TRAVS Travel by mile 2415 4205 301987.902790 $134384.6000 $0.4400
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Subtotal (Total Children Is Unduplicated) 18828 67400 645744.781823 $17746955.4200 $27.4800
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Total 78838 673806.208353 $18911119.1200 $28.0700
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Number of Children (Unduplicated) With at Least One Authorization 20013