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
Eligibility Filter: Program Patients
With the filters selected there were 85600 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 842 912 10119.778576 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 4 26.387302 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 204 232 44045.883329 $1638506.8400 $37.2000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1050 1149 54192.471429 $1638522.5500 $30.2400
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 5 5 7.533333 $778.6400 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 430 533 482.868038 $23419.1300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 158 173 178.661209 $10022.9000 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 90 93 108.436648 $1717.6400 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 696 715 720.961112 $14065.9500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 27 31 59.440476 $1406.9600 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 600 618 620.510046 $9109.0900 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 199 211 178.953965 $3949.5100 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 601 620 636.505557 $5607.6200 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 2.000000 $20.9000 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 611 629 646.750001 $18704.0100 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 8 9 22.577778 $1017.8100 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 154 167 133.261103 $1840.3300 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 637 656 730.253176 $15364.5400 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 2 2 3.144444 $191.8100 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 15 16 29.919841 $2601.2300 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 491 502 500.049999 $37568.7500 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 95 106 89.740107 $4067.0200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 38 43 32.256394 $3735.6100 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 2.785714 $348.2100 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 12 12 13.199923 $660.0000 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 17 20 30.567808 $1528.3900 $50.0000
EXIT -EXIT COS Exit 143 156 122.926422 $6146.3100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 23 29 45.807077 $3435.5300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 35 35 70.000000 $5250.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 9 10 20.000000 $1500.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 10.755556 $806.6700 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 22.000000 $1650.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 28 32 52.440792 $3933.0600 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 49 51 86.451370 $4798.0500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 16 16 29.000000 $1609.5000 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 2 2 2.500000 $138.7500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 502 513 989.704560 $74227.8600 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 167 167 321.085236 $24081.3900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 163 164 321.785714 $24133.9300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 86 87 169.000000 $12675.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 178 180 356.500000 $26737.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 70 72 136.593151 $10244.4900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 759 773 1496.566466 $83059.4500 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 325 327 636.628876 $35332.9000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 464 572 1120.720482 $84054.0500 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 112 126 248.500000 $18637.5000 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 2 2 13.409524 $726.4000 $54.1700
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 50 63 86.877779 $12356.6400 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 23 24 74.706351 $3735.3300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 21 22 117.061906 $5853.1100 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 224 276 159.125800 $8180.6600 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 3 3 1.533334 $78.8300 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 0.644444 $33.1300 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 493 569 463.030988 $23804.3900 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 7 7 3.122222 $160.5100 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 11 13 3.744444 $192.5000 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 87 100 85.286465 $4384.5800 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 8 9 33.748337 $1735.0000 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 6 6 14.462373 $743.5100 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 4 5 3.614438 $185.8200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 279 307 263.978939 $13571.1500 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 18 19 26.265078 $1350.2800 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 102 114 44.019175 $2263.0100 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 6 7 3.061111 $157.3700 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 138 169 88.057880 $4527.0400 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 4 4 2.461111 $126.5300 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.2800 $51.4100
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 2 0.511111 $26.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 228 263 223.932335 $11512.3300 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 7 8 3.438888 $176.7900 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 4 4 1.616666 $83.1100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 63 70 58.105481 $2987.2200 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 7 8 2.498631 $128.4500 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 1.877778 $96.5400 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 2 0.511111 $26.2800 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 186 208 162.737820 $8366.3400 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 9 9 14.115873 $725.6900 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 95 114 46.880950 $2410.1400 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 94 96 95.566667 $4778.3400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 8 9.020091 $136.2900 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 695 799 665.210907 $34198.4400 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 12 12 7.796499 $400.8200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 110 125 54.121428 $2782.3800 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 2 0.938889 $48.2700 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 23 26 18.994291 $976.4900 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 9 10 7.407154 $380.8000 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 11 13 6.110655 $314.1600 $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 638 760 479.814132 $24667.2000 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 26 28 22.537214 $1158.6400 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 13 14 8.205555 $421.8400 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 3 3.000000 $154.2300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 32 35 35.659197 $1833.2300 $51.4100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 10.285714 $528.7900 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 1.596499 $82.0800 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 2.000000 $102.8200 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 85 101 897.038093 $46116.7300 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 10 13 126.285714 $6492.3500 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6495 12978 15981.006554 $819043.8100 $51.2500
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 8 8 8.438890 $357.9000 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 340 411 590.864488 $2954327.5000 $5000.0100
AUD -92630 AUD REHAB PRELING HEARING LOSS 11 15 35.877777 $2488.1200 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 75 80 80.108402 $18554.6800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1570 1996 1946.924782 $97346.4000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 144 165 130.039341 $6501.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 418 496 458.163894 $11454.1100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4106 5379 10953.974178 $547699.1000 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 204 256 424.091277 $21204.6100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 197 253 365.902390 $9147.5800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3334 4226 6719.001729 $335949.9600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 190 230 377.534935 $18876.7900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 123 247 346.489677 $8662.2300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1487 1949 3396.989087 $169849.4300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 94 119 165.015475 $8250.7700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 61 111 206.523018 $5163.0800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4245 5187 7830.483707 $391524.0000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 189 224 309.508332 $15475.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 226 277 463.888108 $11597.2300 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 69 79 1798.071439 $44951.8000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 381 606 4207.494422 $105187.4900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 468 541 4177.762694 $208888.2500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 3.857143 $192.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13686 17925 144504.769532 $7225242.6200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1415 1607 14472.504701 $723626.0200 $50.0000
INTR -T1013 INTERPRETER 324 476 1387.460567 $69373.0300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6909 11050 75692.622553 $908311.9800 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2228 2928 21836.932191 $1571386.3300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 79 96 570.409921 $41046.7300 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 222 280 2949.023802 $169863.8500 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 13 15 117.214285 $6751.5400 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 230 265 2016.506350 $145107.8600 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 4 4 27.314285 $1965.5400 $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 2006 2696 18565.888940 $1336001.6800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 54 68 438.480157 $31553.0600 $71.9600
PHY -97110HM PT SESSION BY PT ASST 131 172 1532.285710 $88198.3900 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 12 13 93.333334 $5372.2500 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 210 268 1894.017460 $136293.5300 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 12 15 51.109523 $3677.8300 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 12 14 4.970016 $570.6300 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 15 15 14.912329 $3424.0100 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 16 19 21.022222 $4826.9100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 26 29 31.833332 $14618.4400 $459.2200
SENS -V5264 EARMOLD 102 125 208.075011 $3772.4000 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3582 4722 35001.293273 $2518693.9900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 103 116 872.533333 $62787.5300 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 21 28 231.802380 $13351.8200 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 3 3 9.428571 $543.0900 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 257 314 2017.092864 $145149.9700 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 8 11 60.844444 $4378.3600 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 9 9 69.428571 $969.2200 $13.9600
TRAV -TRAVS Travel by mile 2898 5331 416923.590160 $185531.0100 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 19772 71473 786630.047859 $20416982.1600 $25.9500
-------------------------------------------------------------------------------------------------------------------------------------
Total 85600 856803.525842 $22874548.5200 $26.7000
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 21067