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 28830 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 555 623 2408.569049 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 6.742857 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 12 14 1660.466666 $61769.3600 $37.2000
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Subtotal (Total Children Is Unduplicated) 569 639 4075.778572 $61769.3600 $15.1600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 220 298 256.017131 $12416.8200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 10 8.746576 $490.6800 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 7.569047 $119.8900 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 8 7.500000 $146.3300 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 1.500000 $35.5100 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 2 2 1.500000 $22.0200 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 0.788889 $17.4100 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 1.544444 $11.1200 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 0.544444 $15.7400 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.500000 $67.6200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 2.344444 $32.3800 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 4.500000 $94.6800 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.283333 $24.6300 $86.9300
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 42 47 47.000000 $3531.1100 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 2.300000 $104.2400 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.500000 $57.9100 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 21 23 33.042542 $1652.1300 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 4 4.568797 $228.4400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 74 76 106.358654 $5317.9400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 0.500000 $37.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 8.000000 $444.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 25 25 50.000000 $3750.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 18 18 36.000000 $2700.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 10 10 20.000000 $1500.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 24 24 47.000000 $2608.5000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 3 3 6.000000 $333.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 8 15.000000 $1125.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 1 2 0.666667 $94.8200 $142.2400
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 6.000000 $300.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 5 15.857142 $792.8600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 11 11 4.877778 $250.7700 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 26 33 30.488889 $1567.4300 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.394444 $20.2800 $51.4000
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 10.285714 $528.7900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 14 14 8.177778 $420.4200 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.566667 $29.1300 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 6 2.388889 $122.8100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 6 7 5.911111 $303.8900 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 2 0.500000 $25.7100 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 7 8 5.144444 $264.4700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.172223 $8.8600 $51.4300
SPCH -92521 EVAL OF SPEECH FLUENCY 35 42 36.252381 $1863.7400 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 0.066667 $3.4300 $51.4300
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 16 19 5.449998 $280.1700 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 2.000000 $102.8200 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 0.033333 $1.7600 $52.8800
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Subtotal (Total Children Is Unduplicated) 550 779 864.842426 $48181.9900 $55.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 39 43 54.789564 $273947.5000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 3 3 2.814155 $140.7100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 3 4 4.800000 $1111.7800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1066 1364 1256.308290 $62815.6100 $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 196 210 206.785236 $5169.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2567 3369 6204.182966 $310209.2000 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 126 160 265.799203 $13289.9600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 170 211 315.373814 $7884.3600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2116 2743 3836.537052 $191826.9300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 103 127 183.442063 $9172.1000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 91 170 255.712692 $6392.8000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 958 1290 2041.877663 $102093.9400 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 64 90 94.876188 $4743.8000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 47 87 130.453969 $3261.3500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2748 3389 4544.152363 $227207.7800 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 121 150 219.352376 $10967.6100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 169 201 325.335717 $8133.4000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 51.285715 $1282.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 3 4 35.714286 $892.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 189 220 1731.690477 $86584.4900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 302 367 2952.703976 $147635.1300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 30 34 310.928571 $15546.4100 $50.0000
INTR -T1013 INTERPRETER 224 306 1215.037302 $60751.8600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5148 8601 54832.634203 $548325.9700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 133 156 1084.379367 $78031.8800 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 11.071429 $796.7000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 22 25 223.571429 $12877.7000 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 1.714286 $123.3600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 12.857143 $925.2000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 131 156 1004.674597 $72296.3800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 4 4 25.714285 $1850.4000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 8 10 78.285713 $4506.1300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 3 3 20.000000 $1439.2000 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 0.142857 $10.2800 $71.9800
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 2.300000 $1056.2100 $459.2200
SENS -V5264 EARMOLD 3 4 2.966667 $53.7900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 178 212 1585.850005 $114117.6600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 6 46.142857 $3320.4400 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.571429 $148.1100 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 2 2 2.980953 $214.5100 $71.9600
TRAV -TRAVS Travel by mile 1970 3601 271027.552903 $120607.2500 $0.4500
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Subtotal (Total Children Is Unduplicated) 9178 27412 356264.914022 $2514739.9800 $7.0600
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Total 28830 361205.535020 $2624691.3200 $7.2700
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Number of Children (Unduplicated) With at Least One Authorization 9699