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
Eligibility Filter: Program Patients
With the filters selected there were 83819 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 841 931 2846.409480 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 168 179 23112.947617 $855179.0500 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1010 1113 25975.211859 $855765.6800 $32.9500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 417 576 442.827185 $21477.2000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 71 77 127.838998 $7121.9200 $55.7100
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 857 991 1083.876984 $25471.1100 $23.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 474 477 477.012699 $11209.8000 $23.5000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 64 67 58.042389 $846.2600 $14.5800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 260 270 203.003781 $4770.6400 $23.5000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 82 84 65.604766 $642.2700 $9.7900
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 33 33 33.000000 $323.0700 $9.7900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 101 105 79.526988 $2284.0200 $28.7200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 43 43 45.027778 $2015.4400 $44.7600
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 4.060882 $344.5200 $84.8400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 129 134 112.554766 $1543.1300 $13.7100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 103 104 111.915981 $2337.9200 $20.8900
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $60.5700 $60.5700
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.022222 $1.9200 $86.2400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 1.011111 $75.4300 $74.6000
AUDE -V5010 ASSESSMENT FOR HEARING AID 69 76 62.589270 $2816.5200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 49 55 41.044596 $4720.1300 $115.0000
BEHV -H2014BA Behavior Analysis - Technician 1 1 13.428571 $654.7800 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 37 42 56.178387 $2808.9300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 9 10 20.000000 $1000.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 163 165 238.746501 $11937.3300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 47 65 122.434051 $9182.5500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 26 27 44.520852 $3339.0600 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 25 25 43.024962 $3226.8700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 10 10 19.000000 $1425.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 21.524962 $1614.3700 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 15 15 22.527778 $1689.5900 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 14 38.357142 $2876.7900 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 7 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 46 46 91.200381 $5061.6200 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 27.000000 $1498.5000 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 456 461 859.597624 $64469.8400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 448 451 857.437259 $64307.7900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 149 150 290.066667 $21755.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 64 65 121.000000 $9075.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 133 134 256.506850 $19238.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 157 157 278.195771 $20864.6900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 709 716 1363.837350 $75692.9900 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 403 403 753.465765 $41817.3500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 290 315 616.066667 $46205.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 122 133 281.788454 $21134.1400 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 23.452381 $1172.6200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 23 27 115.595237 $5779.7600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 225 270 221.679480 $11316.8300 $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 3 3 0.477778 $24.3900 $51.0500
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 1.833333 $93.5900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 339 432 373.071773 $19045.4100 $51.0500
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 0.772223 $39.4300 $51.0600
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 115 124 83.297922 $4252.4100 $51.0500
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 5 5 4.011112 $204.7700 $51.0500
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.100000 $5.1100 $51.0500
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.255556 $13.0500 $51.0600
OCTH -97167 OT EVAL HIGH COMPLEXITY 587 648 492.204668 $25127.2600 $51.0500
OCTH -97167GT OT EVAL HIGH COMPLEXITY 14 16 15.455556 $789.0100 $51.0500
OCTH -97167TL OT EVAL HIGH COMPLEXITY 8 8 5.787519 $295.4500 $51.0500
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 6 7 16.688889 $851.9700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 133 162 103.503139 $5283.8800 $51.0500
PSTF -97164GT PT RE-EVAL EST PLAN CARE 3 3 0.716666 $36.5800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 145 180 120.772664 $6165.4800 $51.0500
PSTH -97161GT PT EVAL LOW COMPLEXITY 5 5 3.127779 $159.6800 $51.0500
PSTH -97161TL PT EVAL LOW COMPLEXITY 3 3 1.674603 $85.4900 $51.0500
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 91 101 71.216207 $3635.6300 $51.0500
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 5 5 3.001903 $153.2500 $51.0500
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 1.388889 $70.9000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 361 423 266.631585 $13611.7200 $51.0500
PSTH -97163GT PT EVAL HIGH COMPLEXITY 5 5 4.438889 $226.6100 $51.0500
PSTH -97163TL PT EVAL HIGH COMPLEXITY 4 5 3.505555 $178.9600 $51.0500
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 4 4 3.977778 $203.0700 $51.0500
SCREEN-T1023 SCREENING 102 107 105.405556 $5270.2800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 9 10 24.432136 $366.4800 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 394 489 528.054799 $26957.2300 $51.0500
SPCH -92521GT EVAL OF SPEECH FLUENCY 17 17 15.583333 $795.5300 $51.0500
SPCH -92521TL EVAL OF SPEECH FLUENCY 6 6 3.911112 $199.6700 $51.0500
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 3.000000 $153.1500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 43 47 49.545435 $2529.3100 $51.0500
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 4 4.000000 $204.2000 $51.0500
SPCH -92522TL EVAL OF SPCH SOUND PROD 6 6 4.233334 $216.1200 $51.0500
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 3 3 0.916666 $46.7900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 894 1044 591.735884 $30208.4300 $51.0500
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 21 22 10.791018 $550.8800 $51.0500
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 10 10 8.133333 $415.2100 $51.0500
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 10 12 6.304871 $321.8700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 84 87 86.473812 $4414.5000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 189 216 168.154078 $7491.3200 $44.5500
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 2.000000 $89.1000 $44.5500
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.1000 $44.5500
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 1.004186 $44.7400 $44.5500
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 48 49 469.836511 $24699.3200 $52.5700
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6317 11144 13440.328682 $724827.4900 $53.9300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 291 364 348.527038 $1742635.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 133 163 277.067092 $13853.3300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 4 66.439682 $4575.0400 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 32 35 48.258807 $3323.0900 $68.8600
AUDE -V5160 DISPENSING FEE BINAURAL 124 133 163.967429 $37712.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1512 1963 1755.159418 $87758.4200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 160 196 131.071067 $6553.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 413 502 439.586788 $10989.7400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3941 5027 9966.756533 $498336.7900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 225 269 540.245627 $27012.2600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 329 384 541.353951 $13533.8100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3080 3986 6300.557007 $315027.1800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 215 231 304.838884 $15241.9200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 177 325 431.365079 $10784.1300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1354 1791 3133.852403 $156692.3500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 117 133 206.103964 $10305.1800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 64 130 159.608325 $3990.1900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4362 5270 8259.736681 $412985.7900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 302 330 453.728956 $22686.4000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 354 405 595.365861 $14884.1200 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 23 32 210.071426 $5251.7800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 252 432 3343.392857 $83584.8300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1522 2008 18255.408263 $912770.3200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 10.857144 $542.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13103 16852 133719.641933 $6685982.8300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1267 1393 9205.288108 $460264.5700 $50.0000
INTR -T1013 INTERPRETER 251 313 1259.606195 $62980.3000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6996 10972 72922.321541 $729223.3100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2271 3124 22462.447593 $1604717.5000 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 65 69 456.638095 $32622.2100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 355 468 3838.743248 $219576.1500 $57.2000
OCCT -97530HMGT OT SESSION BY OT ASST 11 11 88.178572 $5043.8100 $57.2000
OCCT -97530TL OT SESSION BY LICENSED OT 74 81 474.638888 $33908.2300 $71.4400
OCCT -97530TLGT OT SESSION BY LICENSED OT 82 85 447.242066 $31950.9800 $71.4400
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 2.285714 $130.7400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2103 2988 20954.566689 $1496994.3400 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 45 53 289.747618 $20699.6000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 198 274 1818.114283 $103923.4500 $57.1600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 11 13 80.602381 $4607.2400 $57.1600
PHY -97110TL PT SESSION BY LICENSED PT 84 94 543.057146 $38796.0300 $71.4400
PHY -97110TLGT PT SESSION BY LICENSED PT 82 91 492.143655 $35158.7600 $71.4400
PHY -97110TLGTHM PT SESSION BY PT ASST 3 3 36.571429 $2090.4200 $57.1600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 10.000000 $571.6000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.122222 $7.9400 $64.9900
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 4 5 0.632876 $72.1500 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 10 12 4.260122 $971.3000 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 15 17 16.879299 $3848.4600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 30 35 36.133333 $16476.7800 $456.0000
SENS -V5264 EARMOLD 100 123 157.552685 $2835.9500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3940 5348 39260.684110 $2804783.6200 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 105 125 753.516668 $53831.2000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 10 12 47.414286 $2712.0900 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 92 104 739.663494 $52841.6100 $71.4400
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 126 145 952.061119 $68015.2800 $71.4400
SPL -92508HA GROUP SPL SESSION PER CHILD 63 91 534.259526 $7415.5200 $13.8800
SPL -92508TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 5.000000 $69.4000 $13.8800
TRAV -TRAVS Travel by mile 2572 4540 375396.851932 $167051.6000 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 19813 71562 742950.187108 $19161205.5500 $25.7900
-------------------------------------------------------------------------------------------------------------------------------------
Total 83819 782365.727649 $20741798.7200 $26.5100
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 21057