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: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 54264 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 2 2 1.544445 $57.4600 $37.2000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 594 626 5789.169823 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.733333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 149 162 36949.883330 $1374535.6500 $37.2000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 745 791 42741.330931 $1374593.1000 $32.1600
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 4 4 4.344445 $449.0500 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 255 316 288.121470 $13973.9100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 87 90 83.581737 $4688.9500 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 54 60 100.699998 $1595.0800 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 656 698 689.905556 $13460.0600 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 14 15 11.811111 $279.5700 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 543 572 566.626179 $8318.0700 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 136 142 114.176187 $2519.8600 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 544 574 575.538889 $5070.5000 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 550 580 584.166667 $16894.1000 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 7 7.111111 $320.5700 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 95 103 68.544434 $946.5900 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 561 592 625.374853 $13157.8800 $21.0400
AUDE -92602 REPROGRAM COCHLEAR IMPLT <7 1 1 3.333333 $202.4300 $60.7300
AUDE -92650 AEP SCR AUDITORY POTENTIAL 2 4 3.205555 $195.5400 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 5 6 4.016666 $349.2000 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 68 71 69.983333 $5257.8500 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 49 53 44.425646 $2013.3600 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 16 18 14.248858 $1650.1500 $115.8100
EVAL -96111 DEVELOPMENTAL EVALUATION 2 2 0.622223 $31.1200 $50.0100
EVAL -96111GT DEVELOPMENTAL EVALUATION 4 4 7.000000 $350.0000 $50.0000
EXIT -EXIT COS Exit 76 80 60.016440 $3000.8100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 21 23 37.611111 $2820.8300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 27 29 47.161035 $3537.0800 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 6 6 8.148336 $611.1300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 16.022222 $1201.6700 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 11 20.000000 $1500.0000 $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 13 16 26.131812 $1959.8900 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 3 3 3.505556 $262.9200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 42 45 79.994368 $4439.6900 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 8 8 16.000000 $888.0000 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 324 334 634.193602 $47564.5400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 101 101 197.000000 $14775.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 102 103 203.500000 $15262.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 56 56 110.500000 $8287.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 121 121 240.500000 $18037.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 32 32 62.000000 $4650.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 440 456 894.137176 $49624.6300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 197 202 399.000000 $22144.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 268 330 655.505479 $49162.9100 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 84 101 202.000000 $15150.0000 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 1 12.714286 $688.7300 $54.1700
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 23 25 29.066667 $4134.1600 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 12 14 34.633336 $1731.6800 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 17 93.414285 $4670.7300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 123 157 73.322070 $3769.4900 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 3 3 -0.094444 $-4.8500 $51.3900
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 1.022222 $52.5500 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 273 304 259.140257 $13322.4100 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 6 7 5.022222 $258.1900 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 5 5 2.322222 $119.3800 $51.4100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.022222 $52.5500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 47 50 29.655633 $1524.6000 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 6 7 28.828180 $1482.0600 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 4 5 1.396498 $71.7900 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 0.252055 $12.9600 $51.4200
OCTH -97167 OT EVAL HIGH COMPLEXITY 178 199 174.193343 $8955.2700 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 8 9 8.266666 $424.9900 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 81 90 56.431283 $2901.1000 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 2 2 1.344444 $69.1200 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 77 94 46.530593 $2392.1300 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 5 5 1.500685 $77.1500 $51.4100
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 137 148 162.959924 $8377.7800 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 3 3 4.477778 $230.2000 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 1.511111 $77.6900 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 30 33 17.313210 $890.0700 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 3 3.000000 $154.2300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 2 2 0.577778 $29.7000 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 109 120 73.461124 $3776.6500 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.127778 $6.5700 $51.4200
PSTH -97163TL PT EVAL HIGH COMPLEXITY 49 58 20.877776 $1073.3200 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
SCREEN-T1023 SCREENING 41 43 43.000000 $2150.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 6 8.831964 $133.4500 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 376 431 372.478328 $19149.1100 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 10 11 13.551587 $696.6800 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 64 70 59.226180 $3044.7700 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 2 4 1.511111 $77.6900 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 12 14 7.679147 $394.7900 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 6 7 3.726028 $191.5500 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 4 0.557457 $28.6600 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 2 2 1.252055 $64.3700 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 370 436 258.939598 $13312.0500 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 11 11 8.061111 $414.4200 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 9 10 5.072222 $260.7600 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 2 3 3.000000 $154.2300 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 11 14 5.640411 $289.9800 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 4 0.752055 $38.6700 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 41 50 389.723806 $20035.7300 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 4 5 40.228571 $2068.1500 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3882 8484 10168.799334 $481923.8900 $47.3900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 9 9 8.155555 $345.8700 $42.4100
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.011111 $42.8800 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 179 221 288.640824 $1443205.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 17 18 22.777779 $1579.6500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 2.755556 $191.1000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 40 42 46.691269 $10814.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1030 1328 1204.657651 $60233.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 92 104 104.287609 $5214.3700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 234 279 256.069962 $6401.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2736 3544 7358.379309 $367919.2200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 126 146 259.862702 $12993.1400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 137 160 210.777782 $5269.4600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2142 2696 4301.743304 $215087.0200 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 119 138 253.726986 $12686.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 85 161 242.207928 $6055.1800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 978 1242 2148.724525 $107436.1600 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 55 64 101.015477 $5050.7700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 33 57 95.149208 $2378.7400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2733 3277 4929.216234 $246460.6200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 111 125 186.326586 $9316.3000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 165 190 264.729368 $6618.2400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 32 42 1203.000002 $30074.9900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 297 378 3803.215075 $95080.4900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 165 174 1711.949999 $85597.6000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 7 7 53.606349 $2680.3200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 9744 12592 103511.985284 $5175602.8500 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 805 913 7065.519855 $353276.1600 $50.0000
INTR -T1013 INTERPRETER 215 316 1216.652148 $60832.6400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4338 6620 48516.653120 $582200.3000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 1274 1635 12370.067490 $890150.2900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 47 52 432.106348 $31094.4200 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 144 175 1675.373806 $96501.5700 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 7 7 53.571429 $3085.7100 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 246 303 1983.343662 $142721.5000 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 6 6 38.752380 $2788.6200 $71.9600
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 1.428571 $82.2900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 1111 1449 9913.128213 $713348.7800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 36 42 239.840478 $17258.9300 $71.9600
PHY -97110HM PT SESSION BY PT ASST 82 102 873.340475 $50269.5000 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 8 9 59.526190 $3426.3300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 156 190 1287.079372 $92618.2600 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 6 6 41.747619 $3004.1600 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 7 9 2.189802 $251.4100 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 3.033333 $696.4800 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 7 7 9.000000 $2066.4900 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 7 4.944444 $2270.5700 $459.2200
SENS -V5264 EARMOLD 40 50 87.743356 $1590.7900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1766 2274 16820.745284 $1210421.1900 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 61 69 591.190475 $42542.1000 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 13 19 227.585715 $13108.9400 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 3 3 23.714286 $1365.9400 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 210 248 1546.765083 $111305.3000 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 8 9 46.080951 $3315.9900 $71.9600
TRAV -TRAVS Travel by mile 1976 3468 277230.372874 $123367.5300 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 13122 44989 514932.160193 $12469298.3300 $24.2200
-------------------------------------------------------------------------------------------------------------------------------------
Total 54264 567842.290458 $14325815.3300 $25.2300
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 14080