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 47744 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 812 879 9701.261116 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 13.244445 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 39 46 9047.272222 $336558.5300 $37.2000
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Subtotal (Total Children Is Unduplicated) 855 929 18762.200005 $336574.2300 $17.9400
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 3 3 4.533333 $468.5600 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 376 468 406.254469 $19703.3700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 32 36 36.307383 $2036.8500 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 15 15 22.056348 $349.3700 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 52 53 52.027779 $1015.0600 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 6 6 7.472222 $176.8700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 51 53 52.533181 $771.1900 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 19 20 17.677776 $390.1400 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 49 51 52.755557 $464.7800 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 46 48 51.172223 $1479.9000 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 4.577778 $206.3700 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 33 35 28.472221 $393.2000 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 55 58 75.148413 $1581.1200 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 1.261111 $109.6400 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 40 40 39.383333 $2958.8700 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 14 19 16.342999 $740.6600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 10 4.498631 $520.9800 $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 15 16 26.042237 $1302.1100 $50.0000
EXIT -EXIT COS Exit 124 134 107.283565 $5364.1600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 4.115068 $308.6300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 12.000000 $900.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.755556 $56.6700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $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 5 6 12.000000 $900.0000 $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 8 10 15.266667 $847.3000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 7.000000 $388.5000 $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 89 91 171.521916 $12864.1500 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 32 32 64.000000 $4800.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 35 35 69.500000 $5212.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 23 23 44.000000 $3300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 41 42 83.000000 $6225.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 15 15 27.093151 $2031.9900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 161 164 314.021916 $17428.2200 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 75 75 145.593151 $8080.4200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 46 55 108.000000 $8100.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 9 11 22.000000 $1650.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 3 4 2.711111 $385.6000 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 19 20 46.963494 $2348.1900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 9 10 63.614285 $3180.7200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 38 46 21.244674 $1092.2000 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 113 123 103.732841 $5332.8900 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 0.777778 $39.9900 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 4 4 0.955555 $49.1200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 21 15.074277 $774.9700 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 4.857143 $249.7000 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 2.714286 $139.5400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 47 51 32.318720 $1661.5000 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 7 7 4.522222 $232.4900 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 12 13 5.344443 $274.7500 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 25 33 19.333333 $993.9300 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 34 36 36.369048 $1869.7300 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 4 0.933333 $47.9800 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 13 7.361113 $378.4400 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 33 36 23.102381 $1187.6900 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 28 32 11.588888 $595.7800 $51.4100
SCREEN-T1023 SCREENING 8 8 8.000000 $400.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 154 169 144.577024 $7432.6900 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 3 3 3.000000 $154.2300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 27 29 11.266664 $579.2100 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 2.000000 $102.8200 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 2 3 3.588889 $184.5100 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 0.467656 $24.0400 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 111 126 89.690909 $4611.0000 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 6 7 4.148021 $213.2500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 4 3.183333 $163.6500 $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 4 4 2.055556 $105.6800 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 6 7 44.142858 $2269.3800 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 9.571429 $492.0700 $51.4100
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Subtotal (Total Children Is Unduplicated) 1580 2491 2864.875996 $152613.6000 $53.2700
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 1.338889 $56.7800 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 111 128 199.848051 $999240.5000 $5000.0000
AUDE -V5160 DISPENSING FEE BINAURAL 9 11 9.022222 $2089.7200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1462 1851 1784.674639 $89233.8700 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 143 164 129.039341 $6451.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 276 292 240.887495 $6022.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3994 5253 10855.712278 $542786.0200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 204 256 424.091277 $21204.6100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 196 250 355.902389 $8897.5800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3256 4145 6647.483474 $332374.0400 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 190 230 377.534935 $18876.7900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 121 245 343.361899 $8584.0400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1431 1888 3341.783533 $167089.1600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 94 119 165.015475 $8250.7700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 58 107 201.923018 $5048.0800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4161 5096 7754.664663 $387733.0700 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 189 224 309.508332 $15475.3900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 221 271 455.376996 $11384.4500 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 7 7 162.357144 $4058.9300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 45 52 254.109527 $6352.7400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 282 326 2504.279359 $125214.0300 $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 3253 4180 34469.001524 $1723451.0100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 332 376 3291.725379 $164586.4900 $50.0000
INTR -T1013 INTERPRETER 292 428 1240.638453 $62031.9200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6903 11039 75543.051124 $906517.1300 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 433 534 4264.295235 $306858.8100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 15 17 78.303572 $5634.7200 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 36 44 426.200000 $24549.1400 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 3 3 38.142857 $2197.0300 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 17 18 132.453968 $9531.3800 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 15.561904 $1119.8300 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 308 379 2553.557949 $183754.1000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 3 4 22.320634 $1606.1800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 18 21 197.499998 $11368.1100 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 2 3 16.428572 $945.6200 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 33 40 290.277777 $20888.4000 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 1.317808 $302.5800 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 3 4 4.511111 $1035.7900 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 6 4.822222 $2214.4500 $459.2200
SENS -V5264 EARMOLD 13 16 20.929985 $379.4600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 743 906 6758.308726 $486328.0600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 21 23 135.657144 $9761.8800 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 18.250000 $1051.2000 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 6.428571 $370.2900 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 30 32 182.600001 $13139.8700 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 13.142857 $945.7600 $71.9600
TRAV -TRAVS Travel by mile 2892 5322 416800.304446 $185476.1500 $0.4500
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Subtotal (Total Children Is Unduplicated) 14230 44324 583047.503896 $6892662.9300 $11.8200
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Total 47744 604674.579897 $7381850.7700 $12.2100
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Number of Children (Unduplicated) With at Least One Authorization 15083