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: 07-01-23 and 09-30-23 Date of Report: 10-10-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 56232 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 0.422222 $15.7100 $37.2000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 597 642 7486.353173 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.400000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 170 191 38257.677774 $1423185.6000 $37.2000
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Subtotal (Total Children Is Unduplicated) 768 835 45744.853169 $1423201.3000 $31.1100
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 3 3 6.000000 $620.1600 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 256 318 278.125775 $13489.1500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 88 96 85.783952 $4812.4700 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 55 58 68.548413 $1085.8100 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 437 449 463.688890 $9046.5700 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 11 12 23.022222 $544.9400 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 369 381 388.799087 $5707.5700 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 124 133 126.370631 $2788.9900 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 366 378 396.066667 $3489.3500 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.4500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 374 386 406.200000 $11747.3000 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 5 16.511111 $744.3200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 92 101 84.438883 $1166.0900 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 387 398 442.741271 $9315.2800 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 1 0.511111 $31.1800 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 6 6 11.997619 $1043.0700 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 328 335 333.766667 $25075.8900 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 50 54 47.484627 $2152.0000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 15 17 14.162253 $1640.1400 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 10 10 10.199923 $510.0000 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 10 11 16.042237 $802.1100 $50.0000
EXIT -EXIT COS Exit 108 118 91.659982 $4582.9900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 17 22 35.692009 $2676.9000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 28 28 56.000000 $4200.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 12.000000 $900.0000 $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 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 18.000000 $1350.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 21 24 38.940792 $2920.5600 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 37 38 67.183333 $3728.6700 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 12 12 22.000000 $1221.0000 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 0.500000 $27.7500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 331 339 653.182644 $48988.7100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 106 106 200.585236 $15043.8900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 105 106 207.285714 $15546.4300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 53 54 105.500000 $7912.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 120 120 237.500000 $17812.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 46 46 89.000000 $6675.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 511 519 1000.473121 $55526.2700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 211 212 411.535725 $22840.2300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 311 377 740.709524 $55553.2200 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 79 87 170.500000 $12787.5000 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 2 2 13.409524 $726.4000 $54.1700
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 25 28 40.566668 $5769.8200 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 10 10 38.138096 $1906.9200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 13 14 80.366666 $4018.3400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 131 153 95.003576 $4884.1300 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 3 3 1.533334 $78.8300 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 0.644444 $33.1300 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 284 324 278.138559 $14299.0900 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 3 3 1.533333 $78.8300 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 6 7 2.250000 $115.6700 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 50 55 45.375364 $2332.7500 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 6 7 28.798043 $1480.5100 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 3 3 0.890944 $45.8100 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 3 2.966341 $152.5000 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 176 189 183.807098 $9449.5200 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 12 13 11.599999 $596.3500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 71 79 29.808065 $1532.4200 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 4 4 2.522222 $129.6700 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 80 98 51.596496 $2652.5600 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 0.950000 $48.8400 $51.4100
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 2 0.511111 $26.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 132 148 142.127859 $7306.7800 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 3 2.022222 $103.9600 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 0.611111 $31.4200 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 31 33 32.980833 $1695.5500 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 3 3 0.254796 $13.0900 $51.3900
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 106 120 93.959252 $4830.4400 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 6 6 11.615873 $597.1700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 49 55 27.897618 $1434.2100 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 61 62 62.000000 $3100.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 6 7.348858 $111.0400 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 346 402 332.296637 $17083.3500 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 8 8 4.544444 $233.6300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 57 62 31.165877 $1602.2500 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 0.938889 $48.2700 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 16 18 13.703347 $704.4800 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 7 7 3.818265 $196.2900 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 5 6 3.237443 $166.4400 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 1.126027 $57.8900 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 368 433 247.359451 $12716.7200 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 15 16 17.454338 $897.3300 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 10 11 5.755555 $295.8900 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 13 14 7.685388 $395.1100 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 1.085388 $55.8000 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 36 43 333.580954 $17149.3900 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 4 6 54.428571 $2798.1700 $51.4100
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Subtotal (Total Children Is Unduplicated) 3998 7870 9765.629409 $502779.0900 $51.4800
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 5 5 4.033334 $171.0600 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 181 219 310.237822 $1551192.0000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 6 7 7.733333 $536.3000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 43 45 47.661903 $11039.4300 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1051 1328 1253.437651 $62671.9800 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 84 96 79.055341 $3952.7600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 258 305 288.408667 $7210.2200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2683 3549 7131.615936 $356581.0900 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 120 155 246.753180 $12337.6900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 131 170 244.811116 $6120.2900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2268 2904 4467.469986 $223373.4200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 119 146 249.112708 $12455.6600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 91 190 263.706338 $6592.6300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 969 1259 2099.410509 $104970.4800 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 55 70 103.305951 $5165.2900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 38 72 134.621430 $3365.5400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2751 3348 4891.974166 $244598.4600 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 109 124 177.341665 $8867.0600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 143 179 285.641276 $7141.0500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 40 47 1011.785719 $25294.6500 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 295 458 3082.099188 $77052.5700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 242 288 2431.930955 $121596.6000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 1.714286 $85.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9565 12558 101750.342206 $5087520.0600 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1064 1209 11029.134878 $551457.3300 $50.0000
INTR -T1013 INTERPRETER 264 394 1178.674854 $58933.7400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4957 7873 54284.458443 $651413.9000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1288 1696 12464.163135 $896921.5900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 50 60 389.133332 $28002.0500 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 153 195 2130.809518 $122734.7000 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 8 9 73.857142 $4254.1700 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 191 219 1626.185716 $117020.3600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 3 3 14.885714 $1071.1800 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 3.200000 $184.3200 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 13.142857 $757.0300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 1122 1490 10149.079793 $730327.8800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 32 40 246.807141 $17760.2800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 84 104 985.607137 $56731.5800 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 8 9 62.190477 $3579.6700 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 153 188 1349.431745 $97105.1300 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 7 9 20.576190 $1480.6600 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 6 1.417961 $162.8100 $114.8200
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 4.511111 $1035.7900 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 5 6 7.000000 $1607.2700 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 7 7.555555 $3469.6400 $459.2200
SENS -V5264 EARMOLD 39 44 74.075015 $1342.9800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1779 2349 17145.072257 $1233759.7500 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 57 65 543.976191 $39144.5500 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 14 17 161.980951 $9330.1100 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 2 3.000000 $172.8000 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 188 225 1405.137304 $101113.6600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 6 8 34.558730 $2486.8400 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 2 2 9.714285 $135.6100 $13.9600
TRAV -TRAVS Travel by mile 2052 3769 303094.738486 $134877.1700 $0.4500
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Subtotal (Total Children Is Unduplicated) 13218 47527 549078.280584 $12808266.5200 $23.3300
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Total 56232 604588.763162 $14734246.9100 $24.3700
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Number of Children (Unduplicated) With at Least One Authorization 14122