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: 04-01-22 and 06-30-22 Date of Report: 08-08-22 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 56007 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 3 3 15.854762 $586.6200 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 591 660 1863.367426 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 127 136 20526.614284 $759484.7200 $37.0000
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Subtotal (Total Children Is Unduplicated) 719 799 22405.836472 $760071.3500 $33.9200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 267 358 291.329542 $14129.5100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 39 43 88.455664 $4927.8700 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 556 649 717.846825 $16869.4000 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 326 329 328.757143 $7725.7900 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 33 35 30.220167 $440.6100 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 184 190 135.108964 $3175.1000 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 36 36 25.705557 $251.6600 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 20 20 20.000000 $195.8000 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 46 47 37.166668 $1067.4300 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 20 20 20.000000 $895.2000 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 3.000000 $254.5200 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 72 76 67.750001 $928.8500 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 52 52 59.355556 $1239.9400 $20.8900
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $60.5700 $60.5700
AUDE -V5010 ASSESSMENT FOR HEARING AID 27 30 21.600000 $972.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 22 23 19.411035 $2232.2800 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 28 33 43.112634 $2155.6400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 7 7 14.000000 $700.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 108 110 158.746501 $7937.3300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 26 35 71.928571 $5394.6500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 16 16 27.011111 $2025.8300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 20 20 35.522222 $2664.1700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 11.000000 $825.0000 $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 6 6 10.011111 $750.8300 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 11 11 17.022222 $1276.6700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 7 8 26.357142 $1976.7900 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 27 27 45.689270 $2535.7600 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 13 13 25.000000 $1387.5000 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 308 313 573.572662 $43017.9800 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 301 303 573.042347 $42978.1700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 103 104 201.066667 $15080.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 44 45 84.000000 $6300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 85 86 162.006850 $12150.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 95 95 168.276516 $12620.7400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 475 477 900.748461 $49991.5500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 256 256 478.403653 $26551.4000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 203 219 427.000000 $32025.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 81 90 195.788454 $14684.1400 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 23.452381 $1172.6200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 19 22 108.728571 $5436.4300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 156 189 103.661764 $5291.9900 $51.0500
OCTF -97168GT OT RE-EVAL EST PLAN CARE 4 4 1.916667 $97.8500 $51.0500
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 0.283333 $14.4600 $51.0400
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 1 1 0.833333 $42.5400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 194 245 218.416104 $11150.2100 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.505556 $25.8100 $51.0500
OCTH -97165TL OT EVAL LOW COMPLEXITY 2 2 1.505556 $76.8600 $51.0500
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 2 2 1.884921 $96.2200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 66 73 46.165985 $2356.8000 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 3.011112 $153.7200 $51.0500
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.100000 $5.1100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 396 441 314.846207 $16073.0400 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 8 10 10.444444 $533.1900 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 5 5 2.693075 $137.4800 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 5 6 15.688889 $800.9200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 93 113 64.881599 $3312.2300 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 0.544444 $27.7900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 88 110 76.617104 $3911.3100 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 1.505556 $76.8600 $51.0500
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 1.388889 $70.9000 $51.0500
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 55 61 48.503190 $2476.1200 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 1.388889 $70.9000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 228 266 123.694845 $6314.7300 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 3 3 3.000000 $153.1500 $51.0500
PSTH -97163TL PT EVAL HIGH COMPLEXITY 3 4 2.505555 $127.9100 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 1.977778 $100.9700 $51.0500
SCREEN-T1023 SCREENING 60 63 61.405556 $3070.2800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.167123 $17.5100 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 195 246 246.229240 $12570.0300 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 14 14 13.144444 $671.0200 $51.0500
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 0.900000 $45.9500 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 3.000000 $153.1500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 27 29 28.151675 $1437.1500 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 4 4.000000 $204.2000 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.1000 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 0.644444 $32.9000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 503 582 326.297698 $16657.6800 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 15 16 7.185462 $366.8100 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 3.627777 $185.1900 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 7 9 4.204871 $214.6600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 38 40 33.577779 $1714.1500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 105 120 68.664389 $3059.0300 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 2.000000 $89.1000 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 1.004186 $44.7400 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 23 23 255.407937 $13426.8000 $52.5700
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Subtotal (Total Children Is Unduplicated) 3982 6948 8375.771844 $455724.3600 $54.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 180 220 221.712807 $1108564.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 68 80 143.651550 $7182.5600 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 52.439682 $3611.0000 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 23 26 33.431964 $2302.1100 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 78 83 105.951295 $24368.8200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1024 1341 1119.826397 $55991.6200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 112 131 79.013153 $3950.6800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 244 290 222.489198 $5562.2700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2671 3420 6958.980792 $347948.2700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 155 185 355.932536 $17796.6200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 224 265 385.494433 $9637.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2070 2690 4282.091568 $214104.0800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 146 154 190.210314 $9510.5000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 130 253 356.870636 $8921.7700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 913 1200 2021.663130 $101082.9600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 88 99 155.426188 $7771.3000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 50 106 124.847218 $3121.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2802 3374 5336.746261 $266836.5200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 207 229 304.007931 $15200.3800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 242 276 399.917451 $9997.9100 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 17 22 169.499998 $4237.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 200 343 2572.142857 $64303.5800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 952 1289 11941.832096 $597091.5500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9336 11962 95848.256256 $4792413.2900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1012 1111 7301.119057 $365056.1000 $50.0000
INTR -T1013 INTERPRETER 201 249 1062.394290 $53119.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5093 7874 52950.764438 $529507.7100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1396 1955 13909.094439 $993665.7800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 39 43 300.528573 $21469.7700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 252 341 2676.278962 $153083.2100 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 8 8 62.071428 $3550.4800 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 61 66 376.623015 $26905.9700 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 66 68 348.583335 $24902.8000 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 1296 1861 13045.767477 $931989.6800 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 20 22 89.612698 $6401.9300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 135 194 1257.788096 $71895.1900 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 8 10 49.530952 $2831.2000 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 80 89 494.100003 $35298.5400 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 58 61 301.007941 $21504.0300 $71.4400
PHY -97110TLGTHM PT SESSION BY PT ASST 2 2 26.285715 $1502.4900 $57.1600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 10.000000 $571.6000 $57.1600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.194520 $22.1700 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.509589 $116.1900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 6 7 6.498630 $1481.6800 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 12 14 11.727778 $5347.8800 $456.0000
SENS -V5264 EARMOLD 38 45 53.341096 $960.1400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1994 2734 20135.720624 $1438496.0900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 48 58 370.366666 $26458.9800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 8 17.914286 $1024.6900 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 76 87 619.987302 $44291.9400 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 83 93 568.430960 $40608.7300 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 47 66 371.330954 $5154.0700 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.000000 $69.4000 $13.8800
TRAV -TRAVS Travel by mile 1799 3148 286481.029721 $127484.0600 $0.4500
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Subtotal (Total Children Is Unduplicated) 13379 48260 536286.038256 $12616279.9700 $23.5300
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Total 56007 567067.646572 $13832075.6800 $24.3900
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Number of Children (Unduplicated) With at Least One Authorization 14214