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 28366 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 585 630 7409.208729 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.400000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 10 10 3633.038889 $135149.0500 $37.2000
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Subtotal (Total Children Is Unduplicated) 597 642 11043.069840 $135164.7500 $12.2400
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 247 306 271.369306 $13161.4600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 9 6.457535 $362.2700 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 4 4 3.461111 $54.8200 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 15 15 15.000000 $292.6500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.511111 $12.1000 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 14 13.511111 $198.3400 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 7 6.466666 $142.7200 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 13 13 12.511111 $110.2200 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 13 13 12.511111 $361.8200 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.511111 $23.0400 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 3.577777 $49.4100 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 16 16 28.653968 $602.8800 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.261111 $22.7000 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 17 17 17.000000 $1277.2100 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 2.511111 $113.8000 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 2.511111 $290.8100 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 10 10 10.199923 $510.0000 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 10 10 14.042237 $702.1100 $50.0000
EXIT -EXIT COS Exit 97 105 84.017125 $4200.8500 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $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 2 3 6.000000 $333.0000 $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 23 23 46.000000 $3450.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 18.000000 $1350.0000 $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 12 12 24.000000 $1800.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 28 28 56.000000 $3108.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 19 21 42.000000 $3150.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 2 3 1.977778 $281.3000 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 7 7 16.966668 $848.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 7 45.190475 $2259.5300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 10 10 2.600229 $133.6800 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 16 17 14.344444 $737.4500 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 0.111111 $5.7100 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 3.000000 $154.2300 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 2.714286 $139.5400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 13 14 7.249999 $372.7200 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 2 2 0.372222 $19.1300 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 5 7 3.383333 $173.9400 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 13.796826 $709.2900 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 2.177778 $111.9600 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 6 7 3.288890 $169.0900 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.694444 $35.7000 $51.4100
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 25 25 18.083332 $929.6600 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 2 2 0.733334 $37.7000 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 25 29 14.727778 $757.1600 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 2 1.183333 $60.8300 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 2 13.142858 $675.6700 $51.4100
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Subtotal (Total Children Is Unduplicated) 580 821 902.323654 $46945.5400 $52.0300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 46 53 72.626035 $363129.5000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 3.000000 $694.8600 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 989 1246 1181.129169 $59056.5400 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 84 96 79.055341 $3952.7600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 180 194 171.390564 $4284.7700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2623 3480 7076.152448 $353807.9300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 120 155 246.753180 $12337.6900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 130 169 241.744449 $6043.6200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2236 2871 4434.350145 $221717.4200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 119 146 249.112708 $12455.6600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 89 188 260.578560 $6514.4400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 940 1228 2073.577177 $103678.8200 $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 2714 3308 4853.188455 $242659.1900 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 109 124 177.341665 $8867.0600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 140 176 284.730165 $7118.2700 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 73.214286 $1830.3600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 12 14 60.714287 $1517.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 168 197 1669.619047 $83480.9800 $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 476 584 4875.145623 $243757.3500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 43 47 394.923810 $19746.2100 $50.0000
INTR -T1013 INTERPRETER 238 353 1044.602740 $52230.1300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4955 7869 54216.601300 $650599.6100 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 113 133 1053.228570 $75790.3700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 3 3.228571 $232.3300 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 12 15 185.428570 $10680.7000 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 11.857143 $682.9700 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 4 4 37.276190 $2682.4000 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 3.133333 $225.4700 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 93 112 719.102385 $51746.6400 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.285714 $308.4000 $71.9600
PHY -97110HM PT SESSION BY PT ASST 8 8 71.571427 $4119.6600 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 2 9.857143 $567.3700 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 7 8 60.820635 $4376.6600 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 1 2 2.000000 $459.2200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.511111 $234.7100 $459.2100
SENS -V5264 EARMOLD 1 1 0.511111 $9.2700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 162 191 1404.650003 $101078.6800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 8.447619 $607.8900 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 4 5 24.280952 $1747.2500 $71.9600
TRAV -TRAVS Travel by mile 2050 3765 303040.738486 $134853.1400 $0.4500
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Subtotal (Total Children Is Unduplicated) 9060 26903 390620.121784 $2858500.6700 $7.3200
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Total 28366 402565.515278 $3040610.9600 $7.5500
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Number of Children (Unduplicated) With at Least One Authorization 9572