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 29299 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 566 613 3482.874576 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 16 18 1431.811110 $53263.3700 $37.2000
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Subtotal (Total Children Is Unduplicated) 582 631 4914.685686 $53263.3700 $10.8400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 239 317 270.271613 $13108.1900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 6 3.588889 $201.3400 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 34 37 35.200000 $686.7500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.055556 $24.9900 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.055556 $0.8200 $14.6900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.244445 $5.4000 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 0.505556 $3.6400 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.505556 $14.6200 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.055556 $2.5100 $45.1100
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 0.505556 $6.9800 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.055556 $22.2100 $21.0400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 44 48 48.000000 $3606.2400 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.361112 $16.3700 $45.3300
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.361112 $41.8300 $115.8400
EVAL -96111 DEVELOPMENTAL EVALUATION 29 35 40.694826 $2034.7400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 8 9 12.723288 $636.1700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 63 63 91.143217 $4557.1600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 17 17 32.285714 $2421.4300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 15 28.285714 $2121.4300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 19 19 38.000000 $2109.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 6 6 12.000000 $666.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 18 19 37.000000 $2775.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 6 7 14.000000 $1050.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 4 10.066666 $503.3300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 11.704762 $585.2400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 5 7 2.333334 $119.9600 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 33 36 33.550000 $1724.8100 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 2 2 1.316667 $67.6900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 16 19 11.444444 $588.3600 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 3 0.872222 $44.8400 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 2.022222 $103.9600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 6 7 5.994444 $308.1700 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.394445 $20.2800 $51.4200
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 9 5.272222 $271.0400 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.188889 $9.7100 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 45 51 53.237303 $2736.9400 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.511111 $26.2800 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 10 13 4.833332 $248.4800 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 2.000000 $102.8200 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 2 2.000000 $89.7200 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $189.0300 $52.9300
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Subtotal (Total Children Is Unduplicated) 581 802 852.234536 $46258.8200 $54.2800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 28 32.893423 $164466.5000 $4999.9800
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 17 17 27.502522 $1375.1300 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 2 3 3.000000 $694.8600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 982 1286 1077.475037 $53873.8300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 83 92 68.760458 $3438.0100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 163 174 160.400950 $4010.0300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2500 3272 6475.412033 $323770.8900 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 129 153 275.668253 $13783.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 165 204 334.980521 $8374.5200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1994 2559 3900.373080 $195018.5400 $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 945 1249 2059.219265 $102960.9500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 61 70 107.846827 $5392.3500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 93 133.816665 $3345.4100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2691 3274 4856.476962 $242823.6700 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 124 144 233.065079 $11653.2500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 160 192 312.734928 $7818.3900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 97.428571 $2435.7100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 21.714286 $542.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1277 1700 16073.865434 $803693.6700 $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 246 295 2289.342859 $114467.2000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 17 20 154.057143 $7702.8600 $50.0000
INTR -T1013 INTERPRETER 197 246 1161.374527 $58068.7400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5151 8383 55229.365731 $552293.9900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 154 184 1553.388099 $111781.8300 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 12 14 149.142857 $8590.6400 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 13.142857 $945.7600 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 171 200 1411.116670 $101543.9400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 3.714286 $267.2800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 6 6 61.857142 $3560.5100 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 3 3 26.142857 $1881.2400 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 13.142857 $945.7600 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 0.361112 $165.8700 $459.3300
SENS -V5264 EARMOLD 2 3 1.383334 $25.0800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 235 271 2145.194447 $154368.2600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 3 3 19.000000 $1367.2400 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 0.285714 $16.4600 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $945.7600 $71.9600
TRAV -TRAVS Travel by mile 1957 3454 265554.349063 $118171.7000 $0.4500
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Subtotal (Total Children Is Unduplicated) 9803 27866 366394.201794 $3197793.5200 $8.7300
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Total 29299 372161.122016 $3297315.7100 $8.8600
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Number of Children (Unduplicated) With at Least One Authorization 10362