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: 04-01-23 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 57927 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 597 647 3067.066641 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 42.142857 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 162 173 33811.030157 $1257770.3200 $37.2000
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Subtotal (Total Children Is Unduplicated) 761 822 36920.239655 $1257770.3200 $34.0700
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 3 7.000000 $723.5200 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 249 318 269.103919 $13051.5700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 86 92 120.191608 $6742.7500 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 45 45 56.575397 $896.1500 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 112 122 126.342855 $2464.9500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 15 22 25.153967 $595.3900 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 86 97 98.543008 $1446.6100 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 123 136 120.735728 $2664.6700 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 83 93 105.209523 $926.9000 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 3 2.100000 $21.9500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 94 107 119.209523 $3447.5400 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 11 15.648412 $705.4300 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 88 99 144.670632 $1997.9000 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 107 118 138.232538 $2908.4100 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.505556 $30.8400 $61.0100
AUDE -92651 AEP HEARING STATUS DETER I&R 6 7 16.177778 $1406.5000 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 643 681 687.908731 $51682.5900 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 52 57 47.604185 $2157.4200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 16 19.679103 $2279.0300 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 39 50 73.515982 $3675.8100 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 7 7 10.087671 $504.3900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 115 120 111.083106 $5554.1700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 18 23 49.882746 $3741.2000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 27 27 45.544444 $3415.8300 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 10 11 20.005479 $1500.4100 $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 4 4 7.500000 $562.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 13 25.000000 $1875.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 8.005479 $600.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 8 15.000000 $1125.0000 $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 34 34 52.450000 $2910.9700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 6 6 12.000000 $666.0000 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 396 407 781.907889 $58643.1200 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 148 152 294.035029 $22052.6300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 118 118 228.066667 $17105.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 68 70 137.000000 $10275.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 126 126 249.500000 $18712.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 88 89 176.500000 $13237.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 524 543 1047.845983 $58155.4600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 201 208 405.177886 $22487.3700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 259 323 630.285714 $47271.4300 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 89 106 207.642857 $15573.2200 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 2 3 1.384126 $74.9800 $54.1700
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 31 42 44.955555 $6394.0200 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 10 11 38.457143 $1922.8600 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 19 20 130.323809 $6516.1900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 144 184 105.844539 $5441.5600 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 2 2 0.455556 $23.4200 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 297 338 303.952904 $15626.2300 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 1.622222 $83.4000 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 9 9 2.694447 $138.5300 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 69 74 53.331740 $2741.8100 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 6 7 28.413699 $1460.7500 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 4 4 1.159133 $59.5900 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 13.249315 $681.1500 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 176 194 130.838801 $6726.4700 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 13 16 13.872222 $713.1700 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 56 68 24.311913 $1249.9200 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 3 3 1.672223 $85.9700 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 95 122 57.298533 $2945.7700 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 4 5 1.161112 $59.7000 $51.4100
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 1 0.505556 $25.9900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 125 145 105.530161 $5425.3700 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 1.052055 $54.0900 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 0.877778 $45.1300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 35 41 30.332170 $1559.3800 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 8 8 3.939726 $202.5400 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 3 3 0.938889 $48.2700 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 121 144 102.389680 $5263.9000 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 9 9 8.559361 $440.0400 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 43 55 47.216649 $2427.4300 $51.4100
SCREEN-T1023 SCREENING 78 80 81.233333 $4061.6700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 3 1.881736 $28.4300 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 366 420 357.018377 $18354.3900 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 8 9 6.322222 $325.0200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 42 53 19.324609 $993.5100 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 3 3 0.872222 $44.8400 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 18 20 15.615981 $802.8100 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 4 4 3.117960 $160.2900 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 8 8 4.686226 $240.9200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 356 428 218.404078 $11228.2700 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 20 22 18.386617 $945.2600 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 14 18 8.294445 $426.4200 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 2.172222 $111.6700 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 15 19 10.983563 $564.6700 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 6 1.271537 $65.3700 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 20 23 191.352379 $9837.4200 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 3 4 39.571429 $2034.3700 $51.4100
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Subtotal (Total Children Is Unduplicated) 4153 7127 8961.479348 $525645.3900 $58.6600
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 2.177778 $92.3600 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 199 234 360.115393 $1800577.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 4 5.438888 $377.1800 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 42 44 42.072223 $9744.7900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1094 1405 1335.938755 $66797.0700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 95 105 79.680731 $3984.0700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 259 307 288.786297 $7219.6600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2734 3513 6902.776041 $345138.0500 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 135 158 315.433327 $15771.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 171 208 313.999994 $7849.9900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2354 3014 4286.792058 $214339.0800 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 113 136 238.220624 $11910.9800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 98 191 236.760322 $5919.0200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1004 1312 2087.568610 $104378.2300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 55 65 100.811105 $5040.5300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 43 99 146.484914 $3662.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2862 3499 4951.934770 $247596.0200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 119 141 199.013485 $9950.6300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 167 205 333.513488 $8337.8300 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 28 32 589.209521 $14730.2400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 208 380 2320.039680 $58000.9900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 243 277 2118.414679 $105920.7700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9554 12588 100204.109535 $5010206.0000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1474 1788 15528.797598 $776440.0400 $50.0000
INTR -T1013 INTERPRETER 228 301 1168.000197 $58400.0100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5386 8971 58382.116699 $700585.4300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1337 1776 13132.612699 $945022.7000 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 38 41 263.600792 $18968.7000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 173 211 2213.677773 $127507.8600 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 11 16 102.964285 $5930.7500 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 182 239 1571.082542 $113055.0800 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 16.821428 $1210.4800 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 6.066667 $349.4400 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 1 2 13.000000 $748.8000 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 1191 1635 10809.058541 $777819.8300 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 29 33 199.109522 $14327.9000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 80 110 969.511908 $55805.1100 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 5 7 37.964286 $2185.2300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 157 209 1333.612702 $95966.7800 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 8 9 58.864286 $4235.8800 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 8 2.184551 $250.8000 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 2 3 1.505555 $345.6800 $229.6000
SENS -V5060 BEHIND EAR HEARING AID 6 7 6.466667 $1484.8200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 9 11 9.705555 $4456.9600 $459.2200
SENS -V5264 EARMOLD 36 48 58.487672 $1060.3800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1823 2423 18031.073800 $1297516.1000 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 60 75 513.823014 $36974.7100 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 10 93.714286 $5397.9400 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 9.285714 $534.8600 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 187 256 1477.370636 $106311.5700 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 9 11 66.579366 $4791.0500 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 2 3 26.000000 $362.9600 $13.9600
TRAV -TRAVS Travel by mile 2086 3850 315232.341590 $140278.3900 $0.4500
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Subtotal (Total Children Is Unduplicated) 13725 49978 568795.692549 $13355939.7600 $23.4800
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Total 57927 614677.411552 $15139355.4600 $24.6300
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Number of Children (Unduplicated) With at Least One Authorization 14667