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 29853 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 584 632 2983.923785 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 42.142857 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 10 12 2314.466666 $86098.1600 $37.2000
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Subtotal (Total Children Is Unduplicated) 596 646 5340.533308 $86098.1600 $16.1200
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 3.000000 $310.0800 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 238 305 261.559551 $12685.6700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 10 9.538204 $535.0900 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 7.880953 $124.8400 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 4.094444 $79.8800 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 0.505555 $11.9700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 6 4.505555 $66.1400 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 8 5.116666 $112.9200 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 5 6 4.505555 $39.6900 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 6 4.505555 $130.3000 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 0.505555 $22.7900 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 3 0.605555 $8.3600 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 9 8.934126 $187.9700 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.166667 $14.4900 $86.9600
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 29 31 31.000000 $2329.0300 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 2 0.505555 $22.9100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.505555 $58.5400 $115.8000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 36 47 70.099315 $3504.9700 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 7 7 10.087671 $504.3900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 108 113 104.583106 $5229.1700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 3.000000 $225.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 26.005479 $1950.4100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 5 5 10.000000 $750.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 18.000000 $1350.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 12 12 24.000000 $1800.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 12 12 22.005479 $1221.3100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 8 9 18.000000 $999.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 16.000000 $1200.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 2 2 4.000000 $300.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 6 10.266667 $513.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 6 61.747619 $3087.3800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 8 11 2.055557 $105.6800 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 22 23 19.394444 $997.0700 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.505556 $25.9900 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 13.000000 $668.3300 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 14 15 5.233335 $269.0500 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 2.027778 $104.2500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.588889 $30.2800 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 6 7 2.905556 $149.3800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 4 4 2.038889 $104.8200 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.372222 $19.1300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 1.505556 $77.4000 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 7 6.869048 $353.1400 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.500000 $25.7100 $51.4100
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 32 36 30.755556 $1581.1500 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 2 2.000000 $102.8200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 3 3 1.383334 $71.1200 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 1 1 0.172222 $8.8500 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 20 22 6.533336 $335.8900 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 2.505556 $128.8100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.866667 $95.9700 $51.4100
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Subtotal (Total Children Is Unduplicated) 591 821 881.443888 $47134.7100 $53.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 49 54 64.933909 $324668.5000 $4999.9800
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 2.000000 $463.2400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1031 1323 1239.356442 $61967.9500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 95 105 79.680731 $3984.0700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 177 193 175.131116 $4378.2800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2687 3460 6857.109374 $342854.7200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 135 158 315.433327 $15771.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 169 204 309.538883 $7738.4600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2327 2986 4257.703169 $212884.6300 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 112 135 237.231735 $11861.5400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 96 189 235.221433 $5880.5500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 980 1286 2067.363055 $103367.9600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 55 65 100.811105 $5040.5300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 98 144.884914 $3622.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2832 3464 4923.729212 $246185.7300 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 119 141 199.013485 $9950.6300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 160 196 326.496821 $8162.4100 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 3 4 26.500000 $662.5000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 11 45.142855 $1128.5700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 158 182 1434.425394 $71721.2800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 420 495 3887.116665 $194355.8500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 44 51 451.428573 $22571.4300 $50.0000
INTR -T1013 INTERPRETER 209 276 1046.607340 $52330.3700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5384 8964 58282.688128 $699392.2900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 114 129 927.269444 $66726.2700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 1 1 2.285714 $164.4800 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 17 20 172.785714 $9952.4600 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 24.000000 $1382.4000 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 1 1 3.533333 $254.2600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 16.571428 $1192.4900 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 102 123 699.326390 $50323.5100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 3 24.428572 $1757.8700 $71.9600
PHY -97110HM PT SESSION BY PT ASST 6 8 73.571429 $4234.7700 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 6.535714 $376.1900 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 6 6 17.658730 $1270.7300 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 0.505555 $232.1400 $459.1700
SENS -V5264 EARMOLD 1 2 0.505555 $9.1600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 165 192 1364.039678 $98156.3200 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 26.580952 $1912.7700 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 5 6 40.961905 $2947.6200 $71.9600
TRAV -TRAVS Travel by mile 2084 3843 315148.341590 $140241.0100 $0.4500
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Subtotal (Total Children Is Unduplicated) 9560 28386 405258.449369 $2792079.6000 $6.8900
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Total 29853 411480.426565 $2925312.4700 $7.1100
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Number of Children (Unduplicated) With at Least One Authorization 10116