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
Eligibility Filter: Program Patients
With the filters selected there were 83362 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 828 883 7320.149988 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 9.666666 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 176 190 41708.899997 $1551571.0700 $37.2000
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Subtotal (Total Children Is Unduplicated) 1006 1077 49040.261096 $1551628.5200 $31.6400
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 8 8 8.044444 $831.4700 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 421 532 491.221437 $23824.2700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 147 159 160.207230 $8987.6300 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 98 105 154.235637 $2443.0900 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1024 1087 1093.780157 $21339.6500 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 26 28 25.599999 $605.9500 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 851 896 909.313948 $13348.7300 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 215 224 175.398407 $3871.0300 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 850 896 917.891270 $8086.6200 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 857 902 939.200794 $27161.6900 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 9 10 8.816667 $397.4600 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 159 171 116.061095 $1602.7800 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 882 931 1001.294695 $21067.2400 $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 13 15 23.177776 $2015.0600 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 103 106 103.983333 $7812.2700 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 94 100 82.169636 $3723.9300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 41 47 37.380365 $4329.0200 $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 104 109 82.145436 $4107.2600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 32 39 68.220700 $5116.5500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 45 47 83.161035 $6237.0800 $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 11 11 20.022222 $1501.6700 $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 18 18 34.000000 $2550.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 8 8 14.005479 $1050.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 17 21 34.631812 $2597.3900 $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 54 57 98.694368 $5477.5400 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 14 14 24.505479 $1360.0600 $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 480 491 939.210039 $70440.7700 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 153 153 296.500000 $22237.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 161 162 319.500000 $23962.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 74 74 145.500000 $10912.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 191 191 376.500000 $28237.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 50 50 97.500000 $7312.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 668 691 1350.225042 $74937.5100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 284 290 573.500000 $31829.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 424 529 1045.076908 $78380.7700 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 108 134 268.000000 $20100.0000 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 1 1 12.714286 $688.7300 $54.1700
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 47 52 71.077776 $10109.3700 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 26 31 94.692068 $4734.6300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 26 30 142.371430 $7118.5900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 222 277 135.099846 $6945.4800 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 3 3 -0.094444 $-4.8500 $51.3900
OCTF -97168TL OT RE-EVAL EST PLAN CARE 1 2 1.233333 $63.4000 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 2 1.022222 $52.5500 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 469 528 395.937309 $20355.1400 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 11 13 10.255555 $527.2400 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 9 9 4.366666 $224.4900 $51.4100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.022222 $52.5500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 84 95 67.911201 $3491.3300 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 7 8 29.080235 $1495.0200 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 8 9 16.511577 $848.8600 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 2 2 0.424277 $21.8100 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 273 303 240.985883 $12389.0600 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 11 12 10.288888 $528.9500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 123 134 73.942392 $3801.3400 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 4 4 2.366666 $121.6700 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 139 170 103.919874 $5342.5200 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 7 7 2.022907 $104.0000 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.305556 $15.7100 $51.4200
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 1 0.511111 $26.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 235 254 241.375144 $12409.1100 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 8 8 8.522222 $438.1300 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 5 5 2.044444 $105.1000 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 55 61 34.834139 $1790.8300 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 6 7 6.252055 $321.4200 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 5 5 5.644445 $290.1800 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 0.327778 $16.8500 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 204 240 154.803982 $7958.4900 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 1.127778 $57.9800 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 96 111 41.640939 $2140.7400 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
SCREEN-T1023 SCREENING 57 59 59.000000 $2950.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 8 9.149772 $138.2500 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 728 853 715.453185 $36781.4800 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 14 15 25.471744 $1309.5000 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 112 126 82.470622 $4239.7500 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 3 5 1.800000 $92.5400 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 19 22 11.922221 $612.9300 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 8 9 4.803045 $246.9200 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 8 10 2.142845 $110.1700 $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 642 772 458.540659 $23573.5200 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 18 18 12.731430 $654.5200 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 12 14 7.583333 $389.8600 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 3 4 4.000000 $205.6400 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 28 32 20.079299 $1032.2800 $51.4100
SPCH -92610GT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 12.857143 $660.9800 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 5 1.246499 $64.0800 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 2 3.000000 $154.2300 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 101 123 1007.419044 $51791.4500 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 9 11 98.942856 $5086.6500 $51.4100
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Subtotal (Total Children Is Unduplicated) 6356 13816 16614.897927 $787305.4100 $47.3900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 17 18 16.211112 $687.5200 $42.4100
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.011111 $42.8800 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 339 415 645.107083 $3225536.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 28 29 59.173018 $4103.6500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 8.444445 $585.6300 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 64 70 71.568893 $16576.7400 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1576 2028 1954.330879 $97716.7100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 171 194 170.938489 $8546.9100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 384 460 434.360603 $10859.0100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4172 5379 11249.543639 $562477.6600 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 202 235 455.323816 $22766.2000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 202 235 321.155561 $8028.9000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3215 4035 6575.600057 $328779.8800 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 181 212 369.469843 $18473.4900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 118 222 326.135700 $8153.3600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1507 1923 3469.125321 $173456.2000 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 89 109 168.170243 $8408.5200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 53 90 175.269842 $4381.7500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4286 5187 7901.521809 $395076.0000 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 182 205 314.046428 $15702.2900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 255 293 426.147624 $10653.7000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 52 66 1980.571433 $49514.2800 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 377 484 5077.305549 $126932.7800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 283 301 2937.913488 $146895.8400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 9 9 31.320635 $1566.0400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14058 18241 148806.930896 $7440351.8200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1090 1234 9554.524626 $477726.4700 $50.0000
INTR -T1013 INTERPRETER 270 390 1404.588938 $70229.4800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6076 9409 68339.653926 $820076.5200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2184 2836 21495.386567 $1546808.6300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 73 80 621.114283 $44695.4400 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 221 265 2652.740474 $152797.9200 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 11 12 75.178572 $4330.2800 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 306 369 2432.159537 $175018.3100 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 7 7 43.352380 $3119.6400 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 2 2 5.714286 $329.1400 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 1 1 1.428571 $82.2900 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 2002 2651 18368.488556 $1321796.7100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 59 68 441.399210 $31763.1100 $71.9600
PHY -97110HM PT SESSION BY PT ASST 133 167 1417.623808 $81598.4700 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 14 16 119.561905 $6881.9900 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 221 263 1869.855562 $134554.8900 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 9 10 66.957142 $4818.2300 $71.9600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 16 19 7.611415 $873.8600 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 13 16 13.449161 $3088.0500 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 19 20 22.044444 $5061.6100 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 19 24 25.544443 $11730.4500 $459.2200
SENS -V5264 EARMOLD 105 129 223.391251 $4050.0700 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3512 4584 34093.907226 $2453398.3700 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 98 109 901.221428 $64851.9600 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 24 31 369.157144 $21263.4500 $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 277 327 2222.507940 $159931.7800 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 11 12 72.795236 $5238.3600 $71.9600
SPL -92507TLGTHM SPL THERAPY SESSION BY SLP ASST 1 1 7.571429 $436.1100 $57.6000
SPL -92508HA GROUP SPL SESSION PER CHILD 7 10 79.142857 $1104.8400 $13.9600
TRAV -TRAVS Travel by mile 2800 4958 377667.856109 $168062.2200 $0.4500
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Subtotal (Total Children Is Unduplicated) 19747 68469 738586.340229 $20463358.8300 $27.7100
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Total 83362 804241.499252 $22802292.7700 $28.3500
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Number of Children (Unduplicated) With at Least One Authorization 21135