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
Eligibility Filter: Program Patients
With the filters selected there were 81477 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 862 936 6441.179329 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 179 187 48034.252379 $1786874.1800 $37.2000
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Subtotal (Total Children Is Unduplicated) 1038 1123 54475.431708 $1786874.1800 $32.8000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 384 511 434.259474 $21061.5800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 136 145 240.576094 $13496.3200 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 557 610 741.630161 $14469.2100 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 49 55 63.418255 $1501.1100 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 55 62 65.041011 $954.8100 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 228 252 177.234078 $3911.5400 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 51 56 57.423810 $413.4500 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 21 21 22.466667 $234.7800 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 76 82 83.218255 $2406.6700 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 29 33 46.979366 $2117.8300 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 135 145 178.140475 $2460.1200 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 78 84 116.923453 $2460.0700 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 3 3 2.511111 $153.1800 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 8 10 6.927778 $602.3000 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 708 778 820.188257 $61620.7500 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 86 98 86.204642 $3906.8000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 37 42 37.523703 $4345.6700 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 50 59 71.754371 $3587.7200 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 10 11 16.723288 $836.1700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 88 88 122.537661 $6126.8800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 20 25 43.471613 $3260.3800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 30 31 60.005479 $4500.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 18 18 30.010958 $2250.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 15 15 30.000000 $2250.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 9 9 13.005479 $975.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 14 28.000000 $2100.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 5 5 9.000000 $675.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 39 39 67.944031 $3770.8900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 16 18 30.505479 $1693.0600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 377 386 739.845983 $55488.4700 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 225 229 423.605174 $31770.3900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 102 102 198.500000 $14887.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 58 58 110.010958 $8250.8300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 122 123 239.285714 $17946.4300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 116 117 194.563010 $14592.2300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 577 585 1127.592689 $62581.4100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 293 296 537.833525 $29849.7600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 396 515 1018.066667 $76355.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 138 170 336.071429 $25205.3600 $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 39 59 79.311110 $11280.4000 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 6 14.914285 $745.7100 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 28 30 168.852381 $8442.6300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 243 306 147.061594 $7560.4100 $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 471 551 483.511863 $24857.3100 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 1.252055 $64.3700 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 31 35 10.755555 $552.9400 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 111 124 78.322677 $4026.5600 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 13 13 10.930289 $561.9300 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 9 9 4.849999 $249.3300 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 5 5 2.510578 $129.0700 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 396 422 307.399359 $15803.3500 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 13 14 9.305556 $478.4000 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 25 27 13.967275 $718.0600 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 4 4 12.285714 $631.6100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 153 192 120.501388 $6194.9500 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 5 7 2.311111 $118.8100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 205 243 167.673122 $8620.0700 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 5 6 3.224962 $165.7900 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 22 25 19.443649 $999.5900 $51.4100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 0.238356 $12.2600 $51.4200
PSTH -97162 PT EVAL MODERATE COMPLEXITY 70 83 58.412872 $3003.0100 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 12 12 5.524354 $284.0100 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 1.186301 $60.9900 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 2 1.511111 $77.6900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 246 278 184.595328 $9490.0300 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 12 13 5.677626 $291.9000 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 7 9 2.816438 $144.7900 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 3 3 2.022222 $103.9600 $51.4100
SCREEN-T1023 SCREENING 93 98 99.900000 $4995.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 8 9.049316 $136.7300 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 737 900 784.953325 $40354.4400 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 7 7 4.172222 $214.4900 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 41 49 27.252382 $1401.0500 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.511111 $26.2800 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 46 50 40.731810 $2094.0200 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 9 10 8.044444 $413.5600 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 8 8 4.722222 $242.7700 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 3 3 2.022222 $103.9600 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 674 810 457.870742 $23539.0700 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 17 19 12.286301 $631.6400 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 13 16 8.433333 $433.5600 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 10 11 5.808371 $298.6100 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 5 5 3.377778 $173.6500 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 56 64 42.809361 $1920.4300 $44.8600
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 0.511111 $22.9300 $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 32 38 341.933334 $18098.5300 $52.9300
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Subtotal (Total Children Is Unduplicated) 6113 10497 12420.841947 $706978.0700 $56.9200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 296 350 494.223550 $2471118.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 52 52 146.516817 $7325.8300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 9 10 104.711112 $7261.7200 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 10 8.691933 $602.7800 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 68 78 116.252533 $26926.4500 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1541 2018 1770.144215 $88507.3600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 124 140 94.446305 $4722.3000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 365 433 523.394351 $13084.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3748 4910 9540.119390 $477006.3100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 209 245 421.510322 $21075.5200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 247 316 480.317519 $12007.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2960 3818 5898.271096 $294913.4200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 107 121 179.476191 $8973.8100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 133 250 312.047761 $7801.1800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1417 1882 3259.662922 $162983.1500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 101 117 169.115080 $8455.7600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 55 116 158.105554 $3952.6400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4170 5110 7619.939663 $380996.8200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 191 221 374.908732 $18745.4400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 254 301 483.626991 $12090.6900 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 68 88 2131.714290 $53292.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 310 405 4680.919045 $117023.0800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2179 2881 26068.635251 $1303432.4400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 3.214285 $160.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11749 15161 119227.460933 $5961376.9800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1178 1368 10601.861109 $530093.3200 $50.0000
INTR -T1013 INTERPRETER 253 310 1405.291193 $70264.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7144 11769 77559.209693 $775592.5800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2194 2908 22284.823428 $1603616.4900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 48 59 400.755557 $28838.3900 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 242 325 3093.617052 $178192.4600 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 8 9 61.714285 $3554.7400 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 160 179 1095.801993 $78853.9000 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 13 13 83.161904 $5984.3400 $71.9600
OCCT -97530TLHM OT SESSION BY OT ASST 3 3 58.714285 $3381.9400 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 2060 2829 19759.112546 $1421866.0300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 48 55 379.609524 $27316.7100 $71.9600
PHY -97110HM PT SESSION BY PT ASST 146 188 1585.693650 $91272.5500 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 9 11 75.357144 $4337.5600 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 133 160 872.853974 $62810.5200 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 24 26 198.225000 $14264.2600 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 3 4 18.571428 $1068.9800 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 2 3 15.242857 $877.3800 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 10 12 7.352664 $844.1600 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 13 16 11.898708 $2732.1100 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 13 15 15.567275 $3574.3800 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 27 31 36.977779 $16980.9900 $459.2200
SENS -V5264 EARMOLD 88 113 148.343374 $2689.4600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3802 5072 39470.813226 $2840321.1700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 127 150 1103.834919 $79431.9800 $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 177 205 1324.074607 $95280.3600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 29 34 260.476191 $18743.8900 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 18 23 145.819047 $2035.6400 $13.9600
TRAV -TRAVS Travel by mile 2765 4927 365002.390038 $162426.0800 $0.4500
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Subtotal (Total Children Is Unduplicated) 19522 69857 731360.940291 $19592027.2500 $26.7900
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Total 81477 798257.213946 $22085879.5000 $27.6700
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Number of Children (Unduplicated) With at Least One Authorization 20770