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: 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 55897 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 569 639 2618.688888 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 6.742857 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 130 141 30232.861111 $1124662.4300 $37.2000
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Subtotal (Total Children Is Unduplicated) 699 782 32858.292856 $1124662.4300 $34.2300
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 2.000000 $206.7200 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 229 309 263.979383 $12802.9900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 76 83 119.961991 $6729.8600 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 21 21 32.419047 $513.5200 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 105 116 128.273810 $2502.6200 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 19 22 32.362699 $766.0300 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 18 22 29.873429 $438.5400 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 126 137 116.397618 $2568.8900 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 20 23 38.301588 $275.7700 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 5 5 6.033333 $63.0500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 32 36 53.879365 $1558.1900 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 9 12 23.357143 $1052.9400 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 84 100 183.746032 $2537.5300 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 32 35 77.793575 $1636.7800 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.366667 $22.3700 $61.0100
AUDE -92651 AEP HEARING STATUS DETER I&R 6 6 5.202381 $452.3000 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 649 720 763.585998 $57368.2100 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 44 46 42.375268 $1920.4500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 14 33.344695 $3861.6500 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 22 24 35.042542 $1752.1300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 4 4.568797 $228.4400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 81 84 111.144368 $5557.2300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 16 21 34.353424 $2576.5100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 18 18 34.005479 $2550.4100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 13 13 22.500000 $1687.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 7 7 12.011111 $900.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 13 26.000000 $1950.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 14 18 33.505479 $2512.9100 $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 34 34 62.000000 $3441.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 12 12 18.159056 $1007.8200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 377 380 753.072146 $56480.4200 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 135 136 263.675342 $19775.6600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 97 99 195.500000 $14662.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 69 70 138.000000 $10350.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 130 131 254.000000 $19050.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 68 69 135.000000 $10125.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 529 542 1067.215003 $59230.4400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 199 206 391.242009 $21713.9400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 261 319 622.220482 $46666.5500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 98 117 230.500000 $17287.5000 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 1 1.000000 $51.8500 $51.8500
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 29 38 44.777777 $6368.7300 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 29.961905 $1498.0900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 20 23 112.714285 $5635.7200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 145 174 83.057937 $4270.0100 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 2 2 0.683333 $35.1300 $51.4100
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 1.316667 $67.6900 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 298 361 313.342724 $16108.9400 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 1.366667 $70.2600 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 20 21 9.155555 $470.6800 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 76 81 51.384016 $2641.6600 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 6 8 24.811405 $1275.5500 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 6 6 3.561111 $183.0800 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 3 4 11.532290 $592.8800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 210 220 166.736843 $8571.9400 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 8 8 6.144445 $315.8900 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 42 52 18.983330 $975.9200 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 4 4 3.450000 $177.3600 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 94 117 68.951584 $3544.7800 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 5 5 1.905555 $97.9600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 130 155 107.480289 $5525.5700 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 1.246575 $64.0900 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 8 9 3.844444 $197.6400 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 36 42 22.935006 $1179.0900 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 9 12 5.232877 $269.0300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 0.905556 $46.5600 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 133 146 75.691628 $3891.3200 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 6 7 2.808219 $144.3700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 26 33 15.542609 $799.0600 $51.4100
SCREEN-T1023 SCREENING 71 72 74.733333 $3736.6700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 5.284931 $79.8600 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 400 481 385.323352 $19809.4800 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 6 6 3.077778 $158.2300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 33 42 31.649997 $1627.1100 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 3 0.900000 $46.2700 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 26 27 22.760655 $1170.1300 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 3 3 3.000000 $154.2300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 6 7 2.097717 $107.8400 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.500000 $77.1200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 390 466 231.349383 $11893.7100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 14 18 14.583181 $749.7200 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 7 9 5.455555 $280.4700 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 4 2.500000 $128.5300 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 16 17 9.072223 $406.9800 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 4 1.116666 $50.0900 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 16 21 158.695240 $8399.7200 $52.9300
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 3.571429 $189.0300 $52.9300
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Subtotal (Total Children Is Unduplicated) 3994 6769 8570.165332 $512824.0000 $59.8400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 179 211 347.186842 $1735932.0000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 5 3.803044 $190.1500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 5 5 5.727777 $397.2200 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 2.000000 $138.7000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 37 40 65.196946 $15100.9500 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1141 1463 1350.542823 $67527.3300 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 63 77 59.550261 $2977.4900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 287 335 351.314301 $8782.8600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2606 3411 6240.455189 $312022.8200 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 126 160 265.799203 $13289.9600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 171 213 321.873814 $8046.8600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2143 2772 3860.233877 $193011.7700 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 104 128 183.786507 $9189.3200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 92 171 256.151581 $6403.7700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 976 1313 2062.722107 $103136.1600 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 64 90 94.876188 $4743.8000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 48 88 133.453969 $3336.3500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2787 3432 4578.741252 $228937.2200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 121 150 219.352376 $10967.6100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 176 208 333.646829 $8341.1800 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 35 42 907.533337 $22688.3200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 209 303 2595.071435 $64876.7700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 281 330 2531.044053 $126552.0900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9181 12110 94662.528975 $4733123.5200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1254 1566 12401.081758 $620053.8100 $50.0000
INTR -T1013 INTERPRETER 243 333 1269.287302 $63464.3600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5148 8605 54855.205631 $548551.6900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1310 1799 12776.653966 $919407.6200 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 36 45 322.385716 $23198.8600 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 161 203 1998.044448 $115087.3100 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 6 6 44.428571 $2559.0800 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 170 214 1448.373410 $104224.8900 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 6 6 35.246826 $2536.3500 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 5.600000 $322.5600 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 2 2 47.142857 $2715.4300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 1182 1621 11044.619979 $794770.7900 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 28 35 204.883333 $14743.4000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 84 115 953.019052 $54855.7400 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 7 39.750000 $2288.0000 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 140 171 1127.034925 $81101.3500 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 11 16 98.669048 $7100.2400 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 12.857143 $740.0500 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 12.857143 $740.0500 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 6 4.506926 $517.4400 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 2.005556 $460.5100 $229.6200
SENS -V5060 BEHIND EAR HEARING AID 6 6 7.345205 $1686.5300 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 10 11 13.033333 $5985.1500 $459.2200
SENS -V5264 EARMOLD 37 44 56.647870 $1027.0300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1838 2526 18481.771411 $1329947.7000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 71 86 636.169047 $45778.7200 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 11 70.999998 $4089.6000 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 4.000000 $230.4000 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 171 225 1424.407150 $102500.2800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 9 10 61.096826 $4396.5200 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 5 5 22.642858 $316.0900 $13.9600
TRAV -TRAVS Travel by mile 1970 3606 271060.552902 $120621.9300 $0.4500
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Subtotal (Total Children Is Unduplicated) 13161 48346 511974.912876 $12655733.6800 $24.7200
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Total 55897 553403.371064 $14293220.1100 $25.8300
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Number of Children (Unduplicated) With at Least One Authorization 13966