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: 10-01-22 and 12-31-22 Date of Report: 01-23-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 53976 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 588 636 3562.492036 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 135 142 41332.452380 $1537567.2200 $37.2000
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Subtotal (Total Children Is Unduplicated) 720 778 44894.944416 $1537567.2200 $34.2500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 248 329 285.294824 $13836.8100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 77 83 160.436465 $9000.4800 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 365 405 510.896827 $9967.6000 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 25 28 37.912699 $897.3900 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 31 35 41.261177 $605.7200 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 150 168 122.509804 $2703.7900 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 30 33 38.918253 $280.2100 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 13 13 14.466667 $151.1800 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 38 40 46.646031 $1349.0000 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 17 20 29.912699 $1348.4600 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 80 87 123.518253 $1705.7900 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 37 40 74.794456 $1573.6700 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 1.000000 $61.0000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 1.511111 $131.3800 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 463 517 534.675146 $40170.1500 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 38 45 38.781889 $1757.6000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 16 22.312514 $2584.0300 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 30 36 42.694826 $2134.7400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 8 9 12.723288 $636.1700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 65 65 92.787661 $4639.3800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 11 14 24.334323 $1825.0800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 23 24 46.005479 $3450.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 11 11 21.000000 $1575.0000 $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 11 11 22.000000 $1650.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 8 16.000000 $1200.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 24 24 38.372602 $2129.6800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 7 7 12.000000 $666.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 255 261 501.829546 $37637.2300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 139 140 260.088737 $19506.6500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 64 64 123.500000 $9262.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 30 30 56.005479 $4200.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 86 87 168.785714 $12658.9300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 79 79 131.043833 $9828.2900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 359 367 708.110499 $39300.1400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 189 191 343.170057 $19045.9400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 261 339 669.000000 $50175.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 95 117 231.071429 $17330.3600 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 2 1.000000 $51.8500 $51.8500
MED -99204 OUTPATIENT VISIT, NEW, 45 MINS 1 1 0.888889 $99.4900 $111.9200
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 21 30 34.955554 $4971.7100 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 5 13.780952 $689.0500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 21 23 121.876191 $6093.8200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 137 178 75.509520 $3881.9300 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 1 1 0.216667 $11.1400 $51.4200
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 1.511111 $77.6900 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 281 333 299.349646 $15389.5400 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 22 24 7.133333 $366.7200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 70 79 46.871765 $2409.6700 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 8 8 5.930289 $304.8800 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 7 7 3.338888 $171.6500 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 3 3 2.252055 $115.7800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 232 250 188.761226 $9704.1900 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 8 9 5.383334 $276.7600 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 14 16 7.233943 $371.9100 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 3 3 10.285714 $528.7900 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 92 114 72.980155 $3751.8900 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 4 6 1.800000 $92.5400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 115 137 84.776385 $4358.3500 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 1.202740 $61.8300 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 13 13 4.805554 $247.0500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 43 51 29.157992 $1499.0200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 8 8 4.005480 $205.9300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 151 171 78.362326 $4028.6100 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 7 7 3.378158 $173.6700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 6 8 2.638660 $135.6500 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 1.022222 $52.5500 $51.4100
SCREEN-T1023 SCREENING 58 60 59.833333 $2991.6700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 5 5.491325 $82.9700 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 335 403 347.686035 $17874.5100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 0.888889 $45.7000 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 23 27 19.413493 $998.0500 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 29 33 31.286301 $1608.4300 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 5 4.022222 $206.7800 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 3 1.994444 $102.5300 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.022222 $1.1400 $51.3600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 423 512 267.974323 $13776.5300 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 11 12 9.155556 $470.6900 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 10 12 7.222222 $371.2900 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 8 8 4.330593 $222.6400 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 3 3 2.366667 $121.6700 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 24 28 13.496196 $605.4400 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 1.966667 $88.2300 $44.8600
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.8600 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 14 16 140.857143 $7455.5800 $52.9300
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Subtotal (Total Children Is Unduplicated) 3741 6385 7656.788668 $435771.3300 $56.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 172 208 287.612027 $1438061.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 27 27 119.732267 $5986.6100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 5 83.434921 $5786.2100 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 7 6.180822 $428.6400 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 39 46 84.640019 $19604.3200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1043 1366 1156.685259 $57834.3400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 84 93 70.760458 $3538.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 223 254 252.569206 $6314.2400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2527 3305 6496.795366 $324840.0600 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 129 153 275.668253 $13783.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 167 208 336.805483 $8420.1500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2017 2583 3927.377842 $196368.7800 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 65 71 105.466666 $5273.3300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 93 189 235.667851 $5891.6800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 963 1269 2079.824820 $103991.2200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 61 70 107.846827 $5392.3500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 44 95 136.549999 $3413.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2727 3317 4895.983312 $244799.0000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 124 144 233.065079 $11653.2500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 164 196 315.057151 $7876.4500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 46 57 1410.857144 $35271.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 232 310 3184.061902 $79601.6300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1393 1858 17055.598762 $852780.4100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 0.928571 $46.4300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8340 10741 84859.683621 $4242987.0100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 905 1055 8324.604745 $416230.4800 $50.0000
INTR -T1013 INTERPRETER 210 262 1205.865003 $60293.2600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5151 8383 55229.365731 $552293.9900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1305 1758 13613.417467 $979621.9700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 29 40 294.361508 $21182.2600 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 166 221 2045.614674 $117827.5000 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 4 4 32.714286 $1884.3400 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 136 151 933.516278 $67175.8300 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 6 6 38.695237 $2784.5100 $71.9600
OCCT -97530TLHM OT SESSION BY OT ASST 3 3 58.714285 $3381.9400 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 1200 1685 11909.653401 $857018.7400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 28 31 212.776191 $15311.3800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 96 125 1091.607937 $62832.9700 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 7 44.178572 $2542.9200 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 113 138 722.568258 $51995.9800 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 13 13 125.948809 $9063.2700 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 2 2 12.000000 $690.7200 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 1 2 13.142857 $756.5100 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 4 6 3.315221 $380.6200 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 2.150685 $493.8200 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 7 9 10.137443 $2327.6500 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 11 14 11.727779 $5385.6900 $459.2200
SENS -V5264 EARMOLD 35 45 49.178157 $891.6000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1915 2545 20012.735043 $1440117.2700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 64 74 540.403966 $38887.4900 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 3.207143 $184.7300 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 2 13.142857 $757.0300 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 145 168 1065.484129 $76672.2100 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 13 15 91.361906 $6574.4100 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 12 17 92.604762 $1292.7600 $13.9600
TRAV -TRAVS Travel by mile 1957 3454 265554.349063 $118171.7000 $0.4500
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Subtotal (Total Children Is Unduplicated) 13108 46813 511077.397021 $12594969.6800 $24.6400
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Total 53976 563629.130105 $14568308.2300 $25.8500
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Number of Children (Unduplicated) With at Least One Authorization 13935