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 43150 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 716 780 1939.212103 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 13 13 262.566666 $9714.9600 $37.0000
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Subtotal (Total Children Is Unduplicated) 731 797 2209.178769 $9988.7600 $4.5200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 318 426 339.834541 $16481.9800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 15 18 13.227778 $736.9200 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 17 17 15.261111 $358.6400 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 60 63 62.251587 $1462.9100 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 7 5.883333 $85.7800 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 13 13 9.211111 $216.4600 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 16 18 7.755555 $75.9300 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 3 3.000000 $29.3700 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 18 21 10.655555 $306.0300 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 7 7 5.877778 $263.0900 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.481963 $125.7200 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 19 21 12.255555 $168.0200 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 13 13 11.555555 $241.3900 $20.8900
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 14 13.506382 $607.7800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 7 5.246575 $603.3600 $115.0000
BEHV -H2014BA Behavior Analysis - Technician 1 1 25.714286 $1253.8300 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 49 53 69.687747 $3484.3900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 10 11 20.355556 $1017.7800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 216 217 331.836704 $16591.8400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 11.000000 $825.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 3 3 5.000000 $375.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $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 4 4 7.000000 $525.0000 $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 16 17 26.091629 $1448.0800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 44 44 76.521916 $5739.1500 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 61 61 108.087671 $8106.5800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 35 35 67.500000 $5062.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 5 5 8.000000 $600.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 11 11 18.502740 $1387.7000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 36 36 61.247945 $4593.6000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 135 135 255.524656 $14181.6200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 75 76 133.756164 $7423.4700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 44 49 97.500000 $7312.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 13 16 6.494445 $331.5400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 32 35 36.988889 $1888.2800 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 14 15 10.853968 $554.1000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 129 139 147.962179 $7553.4800 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 4 4 3.955556 $201.9300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 9 10 5.400000 $275.6700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 8 9 6.738889 $344.0200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 3.111111 $158.8200 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 61 71 84.006337 $4288.5200 $51.0500
SCREEN-T1023 SCREENING 4 4 4.000000 $200.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 3 3.000000 $45.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 31 34 43.380159 $2214.5500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.438889 $73.4600 $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 0.783333 $39.9900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 107 115 93.207144 $4758.2300 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 4.500000 $229.7300 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.0500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 30 32 30.583333 $1561.2800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 48 52 98.778570 $4400.5800 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 10 10 44.066666 $2316.6000 $52.5700
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Subtotal (Total Children Is Unduplicated) 1343 1999 2502.580861 $135295.9900 $54.0600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 68 85 81.590408 $407953.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.000000 $50.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 30 35 38.811111 $1940.5600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 15 16 22.081377 $1520.5300 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 27 28 23.393651 $5380.5300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1266 1668 1497.109112 $74855.7400 $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 257 276 171.982411 $4299.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3689 4770 9256.360108 $462818.0100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 237 289 573.324606 $28666.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 337 433 515.648420 $12891.2300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2875 3743 6032.841627 $301642.0800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 279 327 395.369843 $19768.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 178 339 418.076190 $10451.9000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1219 1592 2861.464341 $143073.2100 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 127 144 202.214286 $10110.7300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 61 119 150.069443 $3751.7300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4052 4971 7634.456709 $381722.8100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 348 393 497.065876 $24853.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 364 451 535.819053 $13395.4900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 10.428571 $260.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 9 9 69.642857 $1741.0700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 250 352 2116.635710 $105831.7600 $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 3016 3900 32167.381001 $1608367.8000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 131 149 909.569841 $45478.4700 $50.0000
INTR -T1013 INTERPRETER 212 249 1118.862982 $55943.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6651 9887 68794.264931 $687941.9400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 310 387 2837.071443 $202680.2700 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 5 8 25.780952 $1841.7800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 32 39 308.500000 $17646.2100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 6.500000 $371.8000 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 5 5 58.285715 $4163.9400 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 15 17 96.334922 $6882.1500 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 287 360 2594.759120 $185369.5400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 3 4 17.931746 $1281.0400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 20 22 198.500001 $11346.2600 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 12.857143 $734.9100 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 2 2 17.957143 $1282.8600 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 11 13 71.949999 $5140.0900 $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 3 3 3.000000 $195.0000 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 4 3.100000 $1413.6000 $456.0000
SENS -V5264 EARMOLD 13 17 15.915144 $286.4700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 609 737 5470.649995 $390822.9700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 15 17 61.551587 $4397.2400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 17.857143 $1021.4300 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 4.100000 $292.9000 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 18 23 109.914286 $7852.2800 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 12 13 165.428573 $2296.1500 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.428571 $19.8300 $13.8800
TRAV -TRAVS Travel by mile 2414 4200 301925.617075 $134356.8800 $0.4400
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Subtotal (Total Children Is Unduplicated) 13401 40354 450306.861187 $5405938.7300 $12.0100
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Total 43150 455018.620817 $5551223.4900 $12.2000
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Number of Children (Unduplicated) With at Least One Authorization 14193