Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 01
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: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 10480 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 106 122 167.334921 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 5.142857 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.233333 $8.6800 $37.1900
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Subtotal (Total Children Is Unduplicated) 108 124 172.711111 $8.6800 $0.0500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 53 68 78.850750 $3824.2600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 23 24 61.471886 $3448.5600 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 8 8 22.819047 $361.4500 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 10 21.857143 $426.4300 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 8 19.857143 $470.0200 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 10 21.857143 $320.8600 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 8 29.390476 $648.6500 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 9 30.390476 $218.8100 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 3.000000 $31.3500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 8 29.390476 $849.9700 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 8 19.857143 $895.1600 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 7 18.857143 $260.4200 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 18 21 66.910241 $1407.7900 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 4.285714 $372.6000 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1 1 1.000000 $75.1300 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 3 2.246576 $101.8200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 24.532289 $2841.0900 $115.8100
EXIT -EXIT EXIT ASSESSMENT 37 40 46.576908 $2328.8600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 8 13.000000 $975.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 15 29.500000 $2212.5000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 13 13 25.500000 $1415.2500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 41 42 82.500000 $6187.5000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 24 25 50.000000 $3750.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 25 25 49.000000 $3675.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 9 10 20.000000 $1500.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 42 43 84.000000 $6300.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 16 17 34.000000 $2550.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 218 221 435.142857 $24150.4300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 94 99 191.566667 $10631.9500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 231 289 562.220482 $42166.5500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 80 97 192.000000 $14400.0000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 8 8 9.000000 $462.6900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 2.000000 $102.8200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.224658 $62.9600 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 5.284931 $79.8600 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 7.000000 $359.8700 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 3.214286 $165.2500 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.104110 $5.3500 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 2.000000 $89.7200 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 7 9 69.771429 $3692.9900 $52.9300
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Subtotal (Total Children Is Unduplicated) 601 1204 2412.179974 $146603.5900 $60.7800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 50 62 84.298977 $421493.5000 $4999.9800
AUDE -V5160 DISPENSING FEE BINAURAL 15 16 30.991389 $7178.2300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 308 350 417.152580 $20857.6300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 11 13 1.538358 $76.9000 $49.9900
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 58 62 93.739530 $2343.4900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 274 349 759.058737 $37952.9700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 25 34 87.966667 $4398.3400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 15 16 26.988890 $674.7300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 94 111 249.450792 $12472.5300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 11 13 26.452380 $1322.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 7 8 14.722222 $368.0600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 120 153 322.380161 $16119.0200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 13 17 34.333333 $1716.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 7 7 12.655556 $316.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 179 224 464.368259 $23218.4400 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 16 20 41.466665 $2073.3300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 9 10 37.366668 $934.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 130 152 1238.690482 $61934.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1272 1680 13402.271459 $670113.0600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 125 158 1288.071433 $64403.5300 $50.0000
INTR -T1013 INTERPRETER 177 239 738.430158 $36921.5000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 1549 2519 18965.034967 $189650.2100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 45 61 439.333333 $31614.4200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 3 15.857143 $1141.0800 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 1.133333 $81.5500 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 122 154 1178.938096 $84836.3100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 5 62.857143 $4523.2000 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 4 4 26.114287 $1879.1800 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 2 12.857142 $925.2000 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 4 4 3.501370 $401.9800 $114.8100
SENS -V5264 EARMOLD 5 6 5.635617 $102.1700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 111 144 1150.557142 $82794.0600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 17 19 193.857143 $13949.9600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 27.647619 $1989.5200 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 3.714286 $51.8500 $13.9600
TRAV -TRAVS Travel by mile 1555 2533 19019.734969 $8463.7700 $0.4400
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Subtotal (Total Children Is Unduplicated) 1655 9152 60479.168286 $1809293.9500 $29.9200
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Total 10480 63064.059371 $1955906.2200 $31.0100
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Number of Children (Unduplicated) With at Least One Authorization 1800