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 49431 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 814 888 5886.522983 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 42.676190 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 40 44 5839.722222 $217237.6700 $37.2000
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Subtotal (Total Children Is Unduplicated) 857 935 11768.921395 $217237.6700 $18.4600
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 350 451 384.962771 $18670.7400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 41 43 43.652817 $2448.9300 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 8 8 13.522223 $214.1900 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 23 24 22.077778 $430.7400 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 7 9 8.494445 $201.0600 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 24 27 25.800001 $378.7500 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 17 22 15.633334 $345.0300 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 23 26 27.588889 $243.0600 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 22 25 26.205556 $757.8700 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 5 4.538889 $204.6100 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 36 39 29.488890 $407.2400 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 32 35 40.428571 $850.6200 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.505556 $30.8400 $61.0100
AUDE -92651 AEP HEARING STATUS DETER I&R 3 3 2.177778 $189.3400 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 84 87 87.000000 $6536.3100 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 15 9.307153 $421.8000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 7 2.250912 $260.6700 $115.8000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 1.428571 $178.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 42 56 81.726712 $4086.3400 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 7 7 10.087671 $504.3900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 147 156 142.493773 $7124.7000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 8 23.482192 $1761.1700 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 16.011111 $1200.8300 $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 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
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 3 6.000000 $450.0000 $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 11 11 18.505556 $1027.0600 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 1 2 0.022222 $1.2300 $55.4400
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 76 76 144.516437 $10838.7400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 39 39 76.500000 $5737.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 24 46.000000 $3450.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 27 27 53.500000 $4012.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 40 40 74.500000 $5587.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 34 34 63.998630 $4799.9000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 150 152 286.516437 $15901.6700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 53 54 103.998630 $5771.9200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 23 26 50.000000 $3750.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 12 16 31.000000 $2325.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 3 3 6.366667 $905.5400 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 11 12 33.044444 $1652.2200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 8 65.280953 $3264.0500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 40 47 19.011115 $977.3800 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 118 132 113.338890 $5826.7600 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.288889 $14.8500 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 3 3 1.516668 $77.9800 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 18 19 11.275039 $579.6500 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 3 3 14.082192 $723.9700 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 13.000000 $668.3300 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 46 49 32.413606 $1666.4100 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 5 5 3.533334 $181.6500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 18 18 6.638890 $341.3100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 24 27 14.744448 $758.0300 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 37 41 32.714287 $1681.8500 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 3 1.011112 $51.9900 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.372222 $19.1300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 12 14 8.098861 $416.3700 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 40 45 27.013493 $1388.7700 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.461111 $23.7100 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 20 23 8.383336 $431.0000 $51.4100
SCREEN-T1023 SCREENING 4 4 4.000000 $200.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 173 198 163.127894 $8386.4500 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 3 3.000000 $154.2300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 26 29 10.794447 $554.9600 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 2.366667 $121.6700 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.8200 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 0.516666 $26.5600 $51.4000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 92 109 72.377883 $3720.9800 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 6 4.227093 $217.3200 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 5 4.505556 $231.6300 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.277778 $14.2800 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 3 3 20.580953 $1058.0700 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 1584 2402 2694.487999 $149041.7100 $55.3100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 122 139 175.144382 $875722.0000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 2.000000 $138.7000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 9 9 9.594445 $2222.2800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1464 1906 1813.682702 $90684.3100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 164 183 128.116236 $6405.8500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 256 278 238.917231 $5972.9500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4047 5202 10404.276781 $520212.8200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 212 245 490.738883 $24536.9100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 238 289 436.966658 $10924.1500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3334 4262 6402.892817 $320143.9600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 187 221 375.424590 $18771.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 125 240 310.759789 $7769.0100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1466 1929 3331.983665 $166598.8600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 98 118 173.080153 $8653.9800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 60 128 181.584913 $4539.6000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4291 5270 7812.816052 $390639.7600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 201 232 345.332527 $17266.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 242 289 478.153170 $11953.8200 $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 45 50 180.761897 $4519.0400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 443 485 4017.196429 $200859.8300 $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 3118 3989 31637.644433 $1581882.1200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 401 467 4173.336502 $208666.9000 $50.0000
INTR -T1013 INTERPRETER 246 322 1209.821625 $60491.0800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7409 12382 80462.580170 $965551.0100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 428 517 4086.332934 $294052.4900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 10 10 73.030953 $5255.3000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 35 39 399.830158 $23030.2100 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 4 5 35.214286 $2028.3400 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 21 22 163.328569 $11753.1300 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 17.833332 $1283.2900 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 10.857143 $625.3700 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 346 421 2573.377188 $185180.2000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 4 4 32.517461 $2339.9500 $71.9600
PHY -97110HM PT SESSION BY PT ASST 14 18 175.857144 $10122.3300 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 2 13.035714 $750.3300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 26 28 192.301588 $13838.0300 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 2 7.377777 $530.9000 $71.9600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 10.000000 $575.6000 $57.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 1.576408 $361.9600 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 2 2 4.022222 $923.5400 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 6 5.516666 $2533.3300 $459.2100
SENS -V5264 EARMOLD 13 15 20.603500 $373.5400 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 740 931 6911.018249 $497316.9100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 21 26 146.580951 $10547.9700 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.142857 $469.0300 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 13.000000 $748.8000 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 29 34 220.571429 $15872.3300 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 6.714286 $483.1600 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 13.928571 $194.4400 $13.9600
TRAV -TRAVS Travel by mile 2907 5356 422003.999803 $187791.7800 $0.4500
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Subtotal (Total Children Is Unduplicated) 14807 46094 591978.875239 $6775421.4200 $11.4500
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Total 49431 606442.284633 $7141700.8000 $11.7800
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Number of Children (Unduplicated) With at Least One Authorization 15712