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
Eligibility Filter: Program Patients
With the filters selected there were 84895 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
CASE -CASE NON-TCM CASE MANAGEMENT 1 1 0.008333 $0.3100 $37.0600
SCONLY-SCONLY *SERVICE COORDINATION ONLY 811 900 3796.367462 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 45.600000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 173 184 36356.419044 $1352458.7800 $37.2000
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Subtotal (Total Children Is Unduplicated) 986 1088 40198.394839 $1352459.0800 $33.6400
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 364 502 428.091986 $20762.4600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 153 169 213.973035 $12003.8700 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 30 31 55.265872 $875.4100 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 161 174 197.754763 $3858.2000 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 44 52 61.912699 $1465.4700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 41 49 57.914003 $850.1800 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 201 223 169.744192 $3746.2500 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 47 54 69.350000 $499.3200 $7.2000
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 10 11 12.033333 $125.7500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 73 82 99.005554 $2863.2400 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 17 21 33.357143 $1503.7400 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 149 173 242.623808 $3350.6300 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 70 81 130.679767 $2749.5000 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 4 5 2.366667 $144.3700 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 13 14 11.202381 $973.9400 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 998 1091 1157.794935 $86985.1300 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 84 92 75.370548 $3415.7900 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 33 37 44.493704 $5152.8400 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 35 39 65.844195 $3292.2200 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 6 6 5.574276 $278.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 122 125 152.432822 $7621.6600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 23 30 50.931202 $3819.8400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 27 28 52.505479 $3937.9100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 17 17 30.500000 $2287.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 16.000000 $1200.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 9 9 16.011111 $1200.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 19 19 37.500000 $2812.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 6 6 10.000000 $750.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 18 22 41.505479 $3112.9100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 48 48 87.500000 $4856.2500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 17 18 29.659056 $1646.0700 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.000000 $55.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 540 543 1074.572146 $80592.9200 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 220 221 428.180821 $32113.5700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 158 160 313.285714 $23496.4300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 106 107 208.005479 $15600.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 195 196 381.000000 $28575.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 104 106 204.405479 $15330.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 780 796 1564.000717 $86802.0400 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 325 334 639.258446 $35478.8500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 406 520 1004.320482 $75324.0500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 153 178 350.500000 $26287.5000 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 1 1.000000 $51.8500 $51.8500
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 55 71 94.100000 $13383.8400 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 12 13 44.811110 $2240.5500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 29 34 171.971428 $8598.5800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 255 309 149.596826 $7690.7700 $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 510 611 551.054589 $28329.7300 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 4 4 1.664536 $85.5700 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 32 36 14.477776 $744.2900 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 119 128 89.072068 $4579.2100 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 12 14 29.994967 $1542.0400 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 9 9 5.894444 $303.0300 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 6 7 13.089976 $672.9600 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 339 359 261.474016 $13442.3800 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 13 13 10.234127 $526.1400 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 73 89 31.199997 $1603.9800 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 5 5 5.450000 $280.1800 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 146 184 101.979362 $5242.7400 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 7 7 2.772222 $142.5200 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 224 267 235.050740 $12083.9700 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 6 7 4.229908 $217.4600 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 16 18 7.549999 $388.1400 $51.4100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 0.126027 $6.4800 $51.4000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 63 72 48.099923 $2472.8300 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 13 17 6.846577 $351.9900 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 3 3 1.905556 $97.9700 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 3 1.500000 $77.1200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 215 241 133.835877 $6880.5100 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 10 11 4.104794 $211.0300 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 62 78 41.191816 $2117.6800 $51.4100
SCREEN-T1023 SCREENING 116 121 126.133333 $6306.6700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 7 9 10.273972 $155.2400 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 791 988 774.127397 $39797.9100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 10 11 7.236682 $372.0400 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 72 86 48.349994 $2485.6400 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 4 5 1.677778 $86.2600 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 39 42 30.627093 $1574.5400 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 7 7 5.416666 $278.4700 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 11 13 5.364384 $275.7800 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 2.500000 $128.5300 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 627 764 406.460448 $20896.2200 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 25 29 19.191258 $986.6100 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 11 14 6.938888 $356.7200 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 4.000000 $205.6400 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.8200 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 43 47 34.502438 $1547.7900 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 5 1.511110 $67.7800 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 36 44 335.409524 $17753.2000 $52.9300
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 3 3 18.285715 $967.8600 $52.9300
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Subtotal (Total Children Is Unduplicated) 6481 11218 13744.712635 $817471.3600 $59.4800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 311 385 559.150844 $2795751.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 14 14 9.491782 $474.6000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 11 13 27.529363 $1909.1600 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 3.022222 $209.5900 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 61 72 90.272136 $20908.8700 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1695 2175 2060.160096 $103008.3100 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 109 134 97.063072 $4853.1300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 468 570 648.294474 $16207.3800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3913 5101 9458.999234 $472950.0300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 205 249 408.057931 $20402.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 252 314 461.737058 $11543.4400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3147 4070 5926.518798 $296326.0400 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 160 191 286.238888 $14311.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 125 223 335.737046 $8393.4100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1452 1941 3232.711794 $161635.6700 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 102 143 162.042059 $8102.0800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 63 112 159.015083 $3975.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4247 5280 7280.572191 $364028.7200 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 200 247 348.311898 $17415.5800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 265 319 509.381754 $12734.5600 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 50 60 1446.961906 $36174.0400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 288 417 3875.928578 $96898.2000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 887 1034 9474.384172 $473718.8500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 8.142857 $407.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 12790 16959 130096.869895 $6504839.5600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1606 1990 15719.369062 $785968.0800 $50.0000
INTR -T1013 INTERPRETER 307 417 1496.744446 $74837.2100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7113 12047 76373.881047 $763738.3300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2227 3082 21608.078558 $1554916.7300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 58 71 453.361114 $32623.8700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 245 313 3034.806355 $174804.7600 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 10 10 55.678571 $3207.0800 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 226 287 1962.255952 $141203.8600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 12 14 73.123016 $5261.9200 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 2 3 15.028571 $865.6500 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 2 2 47.142857 $2715.4300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 2057 2851 18871.417573 $1357987.1300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 51 60 373.210316 $26856.2400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 131 173 1353.866670 $77928.5200 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 9 11 72.178571 $4154.5900 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 196 246 1625.834923 $116994.9900 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 17 24 161.097619 $11592.6000 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 2 2 14.642857 $842.8400 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 2 2 18.571429 $1068.9700 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 11 13 7.216210 $828.4900 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 11 12 10.014080 $2299.3600 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 12 14 14.509589 $3331.5500 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 27 32 40.522222 $18608.6000 $459.2200
SENS -V5264 EARMOLD 92 119 154.659591 $2803.9800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3702 5114 37228.244421 $2678943.4400 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 132 164 1078.078569 $77578.5400 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 12 72.428569 $4171.8900 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 2 5.142857 $296.2300 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 236 307 2016.901594 $145136.1500 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 25 30 194.303175 $13982.0400 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 11 11 88.985714 $1242.2400 $13.9600
TRAV -TRAVS Travel by mile 2771 5126 377408.510034 $167946.7700 $0.4500
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Subtotal (Total Children Is Unduplicated) 19527 72589 738616.401263 $19701918.1300 $26.6700
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Total 84895 792559.508737 $21871848.5800 $27.6000
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Number of Children (Unduplicated) With at Least One Authorization 20760