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
Eligibility Filter: Program Patients
With the filters selected there were 87066 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 854 933 6059.018218 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 4 94.676190 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 196 209 37476.163491 $1394113.2800 $37.2000
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Subtotal (Total Children Is Unduplicated) 1054 1146 43629.857899 $1394113.2800 $31.9500
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 398 510 463.359869 $22472.9900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 159 173 212.876715 $11942.4000 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 78 78 87.660046 $1388.5400 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 184 198 200.092857 $3903.8100 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 34 44 61.378571 $1452.8300 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 142 157 153.976343 $2260.3700 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 191 213 170.360699 $3759.9100 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 141 155 164.348413 $1447.9100 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 5 5 4.100000 $42.8500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 163 182 186.287303 $5387.4300 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 10 17 22.681746 $1022.5000 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 156 172 204.692857 $2826.8100 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 185 203 232.878570 $4899.7700 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 3 3 4.044445 $246.7100 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 14 18 24.727777 $2149.8300 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 959 1010 1023.453175 $76892.0400 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 91 99 80.249543 $3636.9100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 33 37 31.570275 $3656.1300 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 1.428571 $178.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 46 61 88.143379 $4407.1800 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 10 10 14.093150 $704.6600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 162 173 157.493773 $7874.7000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 31 41 90.655348 $6799.1500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 41 41 71.555555 $5366.6600 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 14 15 28.005479 $2100.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 16.500000 $1237.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 6 6 11.500000 $862.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 18 18 35.000000 $2625.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 8 8 14.005479 $1050.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 12 23.000000 $1725.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 52 52 83.955556 $4659.5400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 9 10 16.022222 $889.2300 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 2 2 2.285714 $126.8600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 585 597 1155.918847 $86693.9400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 206 210 408.535029 $30640.1300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 175 177 344.066667 $25805.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 122 124 242.000000 $18150.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 203 203 396.285714 $29721.4300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 125 126 246.498630 $18487.4000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 785 812 1569.356941 $87099.3200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 296 304 591.176516 $32810.3000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 382 483 944.071428 $70805.3600 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 132 160 314.642857 $23598.2200 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 2 3 1.384126 $74.9800 $54.1700
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 58 77 101.722221 $14467.9400 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 17 18 65.234920 $3261.7400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 28 32 181.528571 $9076.4200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 246 307 172.033438 $8844.3800 $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 2 2 2.000000 $102.8200 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 517 596 514.029394 $26426.2900 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 5 5 2.416667 $124.2400 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 16 16 5.344448 $274.7800 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 117 125 97.597070 $5017.4900 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 11 12 44.495891 $2287.5300 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 6 7 4.159133 $213.8200 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 5 6 13.981963 $718.8100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 282 309 222.211139 $11423.9600 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 17 20 29.377778 $1510.3100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 99 120 41.606359 $2139.0400 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 5 5 4.177779 $214.7900 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 147 184 90.804097 $4668.3400 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 5 6 1.661112 $85.4000 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 1 0.505556 $25.9900 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 227 259 210.210466 $10807.0100 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 6 7 4.063167 $208.8900 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 4 5 1.883334 $96.8300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 64 78 62.196330 $3197.5400 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 13 13 5.756164 $295.9200 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 4 4 1.938889 $99.6800 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.505556 $25.9900 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 205 244 153.911906 $7912.6800 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 13 13 11.165830 $574.0300 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 90 110 67.255545 $3457.6600 $51.4100
SCREEN-T1023 SCREENING 125 128 130.066666 $6503.3300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 6 4.866515 $73.5300 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 742 870 704.247952 $36205.5300 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 13 14 10.571537 $543.4800 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 91 109 40.941281 $2104.8500 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 4 4 0.922222 $47.4100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 31 34 25.804185 $1326.5900 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 6 6 6.117960 $314.5200 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 12 16 6.547336 $336.6000 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 613 735 435.517029 $22390.1700 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 29 32 24.601229 $1264.7500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 17 22 10.800000 $555.2300 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 3.450000 $177.3600 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 33 40 26.641402 $1369.6400 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 6 9 1.504871 $77.3700 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 57 72 703.904761 $36187.7500 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 8 9 64.428572 $3312.2700 $51.4100
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Subtotal (Total Children Is Unduplicated) 6693 11634 14524.683982 $845441.1000 $58.2100
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 3 3.177778 $134.7700 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 346 421 617.649654 $3088248.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 8 9 25.494443 $1768.0300 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 73 79 77.029833 $17841.6400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1578 2064 2022.537162 $101127.0500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 164 183 128.116236 $6405.8500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 400 477 439.836264 $10995.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4140 5309 10490.926781 $524545.3200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 212 245 490.738883 $24536.9100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 241 295 447.994436 $11199.8400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3401 4335 6465.748373 $323286.7400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 188 222 376.413479 $18820.6200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 127 242 312.298678 $7807.4800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1512 1978 3378.183665 $168908.8600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 99 120 180.642057 $9032.0800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 64 133 187.840469 $4695.9900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4359 5351 7878.821611 $393940.0600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 202 233 351.832527 $17591.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 251 302 491.297615 $12282.4300 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 39 46 844.352378 $21108.8200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 286 528 3307.801576 $82695.0300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 625 689 5528.534922 $276426.8000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 13.000000 $650.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13564 17812 140854.067853 $7042703.9400 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1896 2287 19921.711873 $996085.8100 $50.0000
INTR -T1013 INTERPRETER 270 354 1340.464482 $67023.2300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7418 12400 80678.151599 $968137.8700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2276 3023 22381.387292 $1610564.6000 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 62 69 428.394840 $30827.2700 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 244 299 3262.078171 $187895.7000 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 17 24 152.035714 $8757.2600 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 240 316 2185.107937 $157240.3500 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 7 7 27.007142 $1943.4400 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 2 3 16.923810 $974.8100 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 1 2 13.000000 $748.8000 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 2095 2884 19155.228375 $1378410.3000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 51 61 375.438889 $27016.5700 $71.9600
PHY -97110HM PT SESSION BY PT ASST 129 175 1500.897620 $86391.6800 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 8 10 58.857143 $3387.8300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 218 294 1931.960322 $139023.8800 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 16 20 106.808730 $7685.9500 $71.9600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 10.000000 $575.6000 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 13 15 7.011644 $805.0000 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 11 13 6.975037 $1601.5100 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 14 15 16.488889 $3786.0200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 23 28 31.772221 $14590.3800 $459.2200
SENS -V5264 EARMOLD 94 117 163.365067 $2961.8100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3643 4872 36541.740074 $2629543.7800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 112 140 869.634916 $62578.9300 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 13 17 136.178571 $7843.8900 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 3 3 30.571428 $1760.9100 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 258 360 2094.749208 $150738.1600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 14 17 103.365081 $7438.1500 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 9 13 101.042857 $1410.5600 $13.9600
TRAV -TRAVS Travel by mile 2914 5369 422140.285518 $187852.4200 $0.4500
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Subtotal (Total Children Is Unduplicated) 20338 74286 800703.971123 $20912426.0300 $26.1200
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Total 87066 858858.513004 $23151980.4100 $26.9600
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Number of Children (Unduplicated) With at Least One Authorization 21727