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 45249 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 795 846 7126.410304 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 9.666666 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 33 33 5810.327778 $216144.1900 $37.2000
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Subtotal (Total Children Is Unduplicated) 831 883 12947.949193 $216201.6500 $16.7000
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 2 2.555555 $264.1400 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 370 463 418.812501 $20312.4300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 27 29 27.172070 $1524.3500 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 19 19 29.171429 $462.0800 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 62 65 62.661110 $1222.5200 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 4 1.311111 $31.0300 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 47 53 49.152055 $721.5500 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 28 30 21.772222 $480.5100 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 43 48 46.088889 $406.0400 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 43 48 46.577778 $1347.0300 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 4 2.211111 $99.6800 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 39 42 27.527774 $380.1500 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 54 61 67.863492 $1427.8500 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 3 3 1.772222 $154.0800 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 10 10 10.022222 $752.9700 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 23 25 20.126714 $912.1500 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 7 9 4.039879 $467.8600 $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 99 102 75.645436 $3782.2600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 8 14.609589 $1095.7200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 14.000000 $1050.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 4 3.609590 $270.7200 $75.0000
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 9 9 14.344444 $796.1100 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 10.000000 $555.0000 $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 76 77 144.521916 $10839.1500 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 23 23 42.500000 $3187.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 18 18 35.500000 $2662.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 11 11 21.000000 $1575.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 41 41 81.000000 $6075.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 13 13 25.500000 $1912.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 110 116 221.521916 $12294.4700 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 57 59 117.000000 $6493.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 29 39 75.500000 $5662.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 10 11 22.000000 $1650.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 2 2 2.044444 $290.7800 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 22 27 68.549210 $3427.4900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 13 16 74.390477 $3719.5400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 47 54 23.749392 $1220.9600 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 107 114 68.514491 $3522.3300 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 3 1.022222 $52.5500 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 3 3 2.022222 $103.9600 $51.4100
OCTH -97165TLGT OT EVAL LOW COMPLEXITY 1 1 1.022222 $52.5500 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 21 27 27.336162 $1405.3600 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 1 1 0.038356 $1.9700 $51.4700
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 0.511111 $26.2800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 68 72 42.418266 $2180.7300 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 2.022222 $103.9600 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 17 19 9.122221 $468.9700 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 43 51 27.561035 $1416.9100 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 2 2 1.022222 $52.5500 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.305556 $15.7100 $51.4200
PSTH -97161 PT EVAL LOW COMPLEXITY 34 36 38.270635 $1967.5000 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 2 1.533333 $78.8300 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 1 1 0.133333 $6.8500 $51.4000
PSTH -97162 PT EVAL MODERATE COMPLEXITY 11 11 5.527169 $284.1500 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 2 2 2.000000 $102.8200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 36 41 36.542856 $1878.6700 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 26 28 10.605555 $545.2300 $51.4100
SCREEN-T1023 SCREENING 6 6 6.000000 $300.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 182 206 172.057567 $8845.4800 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 4 4 9.857143 $506.7500 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 21 23 9.677776 $497.5300 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.246575 $64.0900 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 3 3 2.077017 $106.7800 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 2 2 0.763166 $39.2400 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 107 130 74.411110 $3825.4700 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 5 5 3.648097 $187.5500 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 3 4 2.511111 $129.1000 $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 2.060578 $105.9400 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $51.4100 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 14 14 115.076190 $5916.0800 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 1 1 1.000000 $51.4100 $51.4100
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Subtotal (Total Children Is Unduplicated) 1517 2397 2628.369846 $135917.1400 $51.7100
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 4 2.722223 $115.4500 $42.4100
AACFIT-92609TL AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.011111 $42.8800 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 115 138 276.953976 $1384768.5000 $5000.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 6.733333 $1559.5700 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1444 1852 1742.745433 $87137.4300 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 171 194 170.938489 $8546.9100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 226 238 192.269632 $4806.7300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4045 5227 11116.673003 $555834.1300 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 202 235 455.323816 $22766.2000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 201 233 316.988894 $7924.7400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3134 3947 6478.479421 $323923.8500 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 181 212 369.469843 $18473.4900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 116 220 323.602367 $8090.0300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1443 1855 3408.786434 $170439.2700 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 89 109 168.170243 $8408.5200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 50 86 174.530954 $4363.2800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4190 5077 7801.778155 $390088.8100 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 182 205 314.046428 $15702.2900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 250 287 416.153180 $10403.8400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 5 6 147.428572 $3685.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 9 26.093653 $652.3500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 183 196 1971.439682 $98572.0800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 6 18.320635 $916.0400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3514 4533 37800.987271 $1890050.6900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 269 299 2305.052387 $115252.6900 $50.0000
INTR -T1013 INTERPRETER 245 359 1331.731795 $66586.6200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6076 9407 68336.587259 $820039.7200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 423 516 4144.700021 $298252.7300 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 16 17 150.699998 $10844.3900 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 48 55 591.914285 $34094.2800 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 5 6 30.857143 $1777.3700 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 24 28 179.128574 $12890.1100 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 1.533333 $110.3400 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 1 4.142857 $238.6300 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 329 401 2791.995250 $200911.9800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 6 6 51.034921 $3672.4700 $71.9600
PHY -97110HM PT SESSION BY PT ASST 22 27 223.483334 $12863.7000 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 4 29.571429 $1702.1300 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 28 31 234.447618 $16870.8900 $71.9600
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 2.796499 $642.1000 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 2 2 3.000000 $688.8300 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 4 6 5.533333 $2541.0000 $459.2200
SENS -V5264 EARMOLD 12 15 13.652053 $247.5100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 723 901 6857.247644 $493447.6600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 19 20 179.714285 $12932.2600 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 8 64.857145 $3735.7600 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 18 19 174.061905 $12525.5200 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 2 2 10.742857 $773.0600 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 13.142857 $183.4700 $13.9600
TRAV -TRAVS Travel by mile 2799 4954 377658.360870 $168058.0000 $0.4500
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Subtotal (Total Children Is Unduplicated) 13830 41969 539092.636400 $7309225.3100 $13.5600
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Total 45249 554668.955439 $7661344.1000 $13.8100
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Number of Children (Unduplicated) With at Least One Authorization 14736