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 48128 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 816 884 6141.659486 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 57 59 7965.611109 $296320.7200 $37.2000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 873 943 14107.270595 $296320.7200 $21.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 338 451 369.588426 $17925.0300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 32 33 42.592857 $2389.4600 $56.1000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 79 82 104.077778 $2030.5600 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 5 3.566667 $84.4200 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 9 10 10.000001 $146.8000 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 14 14 7.283334 $160.7400 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 5 4.450001 $32.0400 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.4500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 11 12 9.572223 $276.8300 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 5.055556 $227.9100 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 20 22 19.672222 $271.6700 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 14 14 13.511112 $284.2800 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.511111 $31.1800 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 2.000000 $173.8800 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 93 98 123.285714 $9262.4500 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 17 19 15.021080 $680.7500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 8 4.643304 $537.7500 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 40 48 59.336911 $2966.8500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 9 10 14.723288 $736.1700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 84 84 117.893217 $5894.6600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 10 17.137290 $1285.3000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 5 5 6.010958 $450.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 6.005479 $450.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 9 9 17.571429 $975.2100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 7 9 15.505479 $860.5600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 68 70 131.796672 $9884.7500 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 47 49 87.016437 $6526.2400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 20 20 39.000000 $2925.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 13 13 24.005479 $1800.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 34 35 66.785714 $5008.9300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 32 33 54.519177 $4088.9400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 128 128 242.982190 $13485.5200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 77 78 142.663468 $7917.8200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 48 55 107.500000 $8062.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 21 26 51.000000 $3825.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 2 3 7.122222 $1012.9900 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 5 11.199999 $560.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 6 27.280952 $1364.0500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 40 48 20.749696 $1066.7400 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 115 127 120.638096 $6202.0000 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 2 2 0.844444 $43.4100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 16 17 11.219406 $576.7800 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.186301 $9.5800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 61 64 48.008655 $2468.1300 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.411111 $21.1300 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 3 0.872222 $44.8400 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 25 33 18.165678 $933.9000 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 33 38 37.339355 $1919.6100 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 3 1.022222 $52.5500 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 3 3 1.361111 $69.9700 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 6 7 3.528996 $181.4300 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.186301 $9.5800 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 36 41 46.137302 $2371.9200 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.093151 $4.7900 $51.4400
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 0.188889 $9.7100 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 5 5 5.000000 $250.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 206 245 254.608504 $13089.4400 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.072222 $3.7100 $51.3900
SPCH -92521TL EVAL OF SPEECH FLUENCY 7 7 1.866666 $95.9600 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 1.582344 $81.3500 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 1.250000 $64.2600 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 89 102 75.431115 $3877.9100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 1.130745 $58.1300 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 2.511111 $129.1000 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 0.477778 $24.5600 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.011111 $0.5700 $51.3600
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 9 15.783333 $708.0400 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $189.0300 $52.9300
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1518 2273 2673.659263 $150192.8200 $56.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 80 89 124.997761 $624988.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 23 23 34.635856 $1731.8000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 2.000000 $138.7000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 14 16 18.078571 $4187.3700 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1425 1860 1576.410630 $78820.6800 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 123 139 92.446305 $4622.3000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 242 260 320.190381 $8004.7700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3701 4853 9497.969391 $474898.8200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 208 244 420.488100 $21024.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 245 312 478.492557 $11962.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2913 3767 5844.782999 $292239.0100 $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 1388 1851 3220.090700 $161004.5400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 101 117 169.115080 $8455.7600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 52 113 152.305553 $3807.6300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4106 5036 7545.255534 $377262.6000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 191 221 374.908732 $18745.4400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 249 296 478.238101 $11955.9700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 6 6 116.714285 $2917.8600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 6 89.285716 $2232.1400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1909 2517 23678.597167 $1183930.4200 $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 2635 3351 26429.220193 $1321461.8800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 209 235 1724.697633 $86234.9100 $50.0000
INTR -T1013 INTERPRETER 236 290 1353.550717 $67677.5500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7141 11765 77497.923980 $774979.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 446 537 4232.311111 $304557.2200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 6 6 18.443255 $1327.1800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 32 37 420.928571 $24245.5000 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 4.928571 $283.8900 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 4 5 31.869842 $2293.3600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 33.190477 $2388.4000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 422 509 3651.461516 $262759.2000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 7 7 71.285714 $5129.7300 $71.9600
PHY -97110HM PT SESSION BY PT ASST 14 15 169.999999 $9785.2100 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 2.000000 $115.1200 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 6 6 56.857142 $4091.4400 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 14.209524 $1022.5200 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 2 6.571428 $378.2600 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.511111 $58.6800 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 2 1.022223 $234.7300 $229.6300
SENS -V5060 BEHIND EAR HEARING AID 2 2 3.044444 $699.0200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 7 5.544445 $2546.1500 $459.2200
SENS -V5264 EARMOLD 13 16 22.405554 $406.2100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 859 1046 8266.213511 $594837.0200 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 20 23 144.419050 $10392.4000 $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 9 9 73.733334 $5305.8500 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $945.7600 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 37.857142 $528.4900 $13.9600
TRAV -TRAVS Travel by mile 2765 4927 365002.390038 $162426.0800 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 15021 44912 544020.760752 $6957064.0000 $12.7900
-------------------------------------------------------------------------------------------------------------------------------------
Total 48128 560801.690610 $7403577.5500 $13.2000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 15947