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 48425 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 769 853 3185.260323 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 6.742857 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 52 54 7541.963488 $280561.0300 $37.2000
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Subtotal (Total Children Is Unduplicated) 824 910 10733.975001 $280561.3400 $26.1400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 312 433 362.413327 $17577.0500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 46 50 47.210862 $2648.5300 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 5 24.854761 $393.7000 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 23 25 33.080953 $645.4100 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 7 8 8.833333 $209.0800 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 10 12 11.683333 $171.5100 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 14 16 14.572222 $321.6100 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 11 12.227777 $88.0400 $7.2000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 10 13 12.772221 $369.3700 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 4.333333 $195.3500 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 27 29 22.455554 $310.1100 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 15 18 21.450000 $451.3100 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 2 0.500000 $30.5000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 3 3 2.283333 $198.5100 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 110 115 135.428571 $10174.7500 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 15 18 12.282039 $556.6200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 8 4.102739 $475.1500 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 31 33 44.957687 $2247.8900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 6 6 5.574276 $278.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 107 109 142.361394 $7118.0800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 4.577778 $343.3400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 10 10 18.500000 $1387.5000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 2.500000 $187.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 15.500000 $1162.5000 $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 3 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 12 21.500000 $1193.2500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 3 3 5.500000 $305.2500 $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 73 73 144.000000 $10800.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 55 55 106.505479 $7987.9100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 29 29 56.500000 $4237.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 27 27 51.005479 $3825.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 42 42 81.500000 $6112.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 33 34 64.405479 $4830.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 162 165 322.500000 $17898.7500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 79 79 151.516437 $8409.1700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 39 46 91.000000 $6825.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 18 20 39.500000 $2962.5000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 4 5 7.711111 $1096.7500 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 7 8 15.206348 $760.3200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 7 29.428571 $1471.4300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 46 51 21.427780 $1101.6100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 113 136 147.174605 $7566.2500 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 4 5 1.788888 $91.9600 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 17 15.035464 $772.9800 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 2 2 1.183562 $60.8500 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.333333 $17.1400 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 11.096825 $570.4900 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 51 52 30.527093 $1569.4000 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 1.366667 $70.2600 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 5 5 1.400001 $71.9800 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 22 27 9.316667 $478.9700 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.366667 $18.8500 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 36 42 45.718254 $2350.3700 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 3 0.983333 $50.5500 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 0.983333 $50.5500 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 11 5.607231 $288.2700 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 3 2.202740 $113.2400 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 36 40 19.999999 $1028.1900 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 10 11 1.766668 $90.8300 $51.4100
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 187 232 191.332450 $9836.3900 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 0.158904 $8.1700 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 15 16 6.488888 $333.5900 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 1.650000 $84.8300 $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 1.266667 $65.1200 $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 81 104 69.243151 $3559.7900 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 1.837367 $94.4600 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 4 2.500000 $128.5300 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.500000 $25.7100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 1.155556 $51.8400 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 12.461904 $659.6100 $52.9300
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Subtotal (Total Children Is Unduplicated) 1546 2347 2785.108394 $159280.1700 $57.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 101 121 155.353348 $776766.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 5 5 4.514155 $225.7100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 10 13 13.300000 $3080.5500 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1571 2011 1824.477083 $91224.1600 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 108 133 97.060332 $4852.9900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 300 327 371.353220 $9283.8500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3850 5030 9399.099234 $469955.0300 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 204 248 407.524598 $20376.2300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 250 310 453.103725 $11327.6100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3091 4008 5873.066417 $293653.4200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 159 190 285.894444 $14294.7200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 124 222 335.298157 $8382.4400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1418 1899 3193.950684 $159697.6200 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 102 141 158.794440 $7939.7000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 61 109 150.615083 $3765.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4186 5210 7218.635682 $360931.8900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 200 246 346.097612 $17304.8700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 256 307 489.242864 $12231.0900 $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 9 10 67.714286 $1692.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 673 780 7621.715911 $381085.5400 $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 2776 3666 27333.369101 $1366667.5200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 315 374 2967.501589 $148374.9800 $50.0000
INTR -T1013 INTERPRETER 278 379 1423.244446 $71162.2200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7111 12036 76295.023906 $762949.7600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 449 570 4185.396029 $301180.9900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 10 10 51.170636 $3682.2400 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 39 48 420.714285 $24233.1400 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 15 16 99.798416 $7181.4900 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 5 25.019047 $1800.3700 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 9.428571 $543.0900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 389 491 3153.848797 $226950.9000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 8 8 41.755555 $3004.7400 $71.9600
PHY -97110HM PT SESSION BY PT ASST 16 20 143.857143 $8280.4100 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 5.214286 $300.1400 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 14 15 96.500000 $6944.1400 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 8.142857 $585.9600 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 1.785714 $102.7800 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 5.714286 $328.9200 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.377778 $43.3800 $114.8200
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.219178 $279.9400 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 2 3 3.000000 $688.8300 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 7 7.300000 $3352.3100 $459.2200
SENS -V5264 EARMOLD 15 20 22.762101 $412.6800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 774 997 7497.242059 $539501.3300 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 21 24 125.928569 $9061.8200 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.571429 $148.1100 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 1.142857 $65.8300 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 19 20 186.766667 $13439.7300 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 0.428571 $30.8400 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 18.928571 $264.2400 $13.9600
TRAV -TRAVS Travel by mile 2771 5119 377368.367178 $167928.9100 $0.4500
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Subtotal (Total Children Is Unduplicated) 14292 45168 540031.759469 $6319391.8500 $11.7000
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Total 48425 553550.842864 $6759233.3600 $12.2100
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Number of Children (Unduplicated) With at Least One Authorization 15173