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 26330 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 578 609 5729.338076 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 0.733333 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 10 10 1331.822222 $49543.7900 $37.2000
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Subtotal (Total Children Is Unduplicated) 591 622 7063.438076 $49601.2400 $7.0200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 245 301 279.343083 $13548.1600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 5.747793 $322.4500 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 5 5 15.082540 $238.9100 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 18 19 19.000000 $370.6900 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 2 0.511111 $12.1000 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 16 14.511111 $213.0200 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 8 9 6.105555 $134.7500 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 13 15 13.511111 $119.0300 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 14 16 14.511111 $419.6600 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 3 1.511111 $68.1200 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 7 8 4.111110 $56.7700 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 16 18 24.796825 $521.7200 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 1 1 0.511111 $44.4400 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 7 7 7.000000 $525.9100 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 7 5.477778 $248.2500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 3 1.511111 $175.0000 $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 73 75 55.516440 $2775.8100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.109590 $8.2200 $75.0100
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 1 0.005556 $0.4200 $75.5900
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $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 14 14 26.005479 $1950.4100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 4 4 7.500000 $562.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 14 28.000000 $2100.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 9 9 16.005479 $888.3100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 7 8 15.500000 $860.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 1 1 2.000000 $150.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 2 2 2.044444 $290.7800 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 11 21.633335 $1081.6800 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 7 10 44.666667 $2233.3400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 13 17 5.832727 $299.8700 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 19 19 27.237302 $1400.2700 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.022222 $52.5500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 5 5 4.338889 $223.0600 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.038356 $1.9700 $51.4700
OCTH -97167 OT EVAL HIGH COMPLEXITY 24 24 14.305556 $735.4500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 5 5 2.194444 $112.8100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 9 11 3.466666 $178.2200 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.000000 $51.4100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 16.159524 $830.7700 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 1.171689 $60.2400 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 10 10 5.566666 $286.1800 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 4 5 1.911111 $98.2500 $51.4100
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 42 47 31.650000 $1627.1300 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 7.857143 $403.9300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 3 3 1.105555 $56.8300 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $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 32 37 21.849999 $1123.3000 $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 1 1 0.038356 $1.9700 $51.4700
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 7 7 71.285714 $3664.8100 $51.4100
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Subtotal (Total Children Is Unduplicated) 569 829 910.883593 $45122.9000 $49.5400
EI Services, Class # 03
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.011111 $42.8800 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 48 57 80.610783 $403053.0000 $4999.9900
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 1.000000 $231.6200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 958 1227 1102.323630 $55116.2900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 92 104 104.287609 $5214.3700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 149 159 131.745583 $3293.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2671 3466 7286.168992 $364308.7100 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 126 146 259.862702 $12993.1400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 136 159 209.177782 $5229.4600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2103 2652 4254.732987 $212736.5100 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 119 138 253.726986 $12686.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 83 159 239.674595 $5991.8500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 945 1208 2117.646749 $105882.2800 $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 2687 3228 4870.955915 $243547.6000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 111 125 186.326586 $9316.3000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 164 189 264.634924 $6615.8800 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 3 3 42.285715 $1057.1400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 1 1 1.555556 $38.8900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 119 126 1285.819046 $64291.0200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 5 44.606349 $2230.3200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 572 693 5908.009523 $295400.6300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 44 51 372.419048 $18620.9700 $50.0000
INTR -T1013 INTERPRETER 198 293 1157.295005 $57864.7800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 4338 6618 48513.586453 $582163.5000 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 111 124 1053.189688 $75787.5800 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 29.742857 $2140.3000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 17 21 169.428571 $9759.0800 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 2 2 10.000000 $576.0000 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 9 11 73.669842 $5301.2900 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 1.533333 $110.3400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 86 95 743.270633 $53485.7600 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 2 2 1.714286 $123.3500 $71.9600
PHY -97110HM PT SESSION BY PT ASST 8 10 55.780953 $3210.7400 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 9.857143 $567.3700 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 5 6 41.304762 $2972.2900 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 0.511111 $234.7100 $459.2100
SENS -V5264 EARMOLD 1 2 0.511111 $9.2700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 167 189 1505.209531 $108314.9100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 4 4 38.428571 $2765.3300 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 5 19.428573 $1119.0800 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 4 4 22.642858 $1629.3800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 1 1 4.600000 $331.0200 $71.9600
TRAV -TRAVS Travel by mile 1975 3465 277223.734778 $123364.5800 $0.4500
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Subtotal (Total Children Is Unduplicated) 8664 24879 359891.186915 $2867388.5900 $7.9700
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Total 26330 367865.508584 $2962112.7400 $8.0500
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Number of Children (Unduplicated) With at Least One Authorization 9227