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: 07-01-22 and 06-30-23 Date of Report: 07-25-23 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 135881 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 0.166667 $6.2000 $37.2100
SCONLY-SCONLY *SERVICE COORDINATION ONLY 1329 1624 12918.076188 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 48.885714 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 318 358 146149.908725 $5436776.5900 $37.2000
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Subtotal (Total Children Is Unduplicated) 1645 1985 159117.037294 $5436782.7900 $34.1700
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 3 7.000000 $723.5200 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 461 716 796.472000 $38628.9000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 144 167 454.487954 $25496.7800 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 47 47 82.394443 $1305.1300 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 750 911 1198.339680 $23379.6000 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 119 133 161.429365 $3821.0300 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 122 144 171.999229 $2524.9500 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 300 353 392.582974 $8664.3300 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 121 140 192.423809 $1695.2500 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 22 22 26.600000 $277.9700 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 142 169 220.512699 $6377.2300 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 24 36 65.918254 $2971.6000 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 158 199 398.040473 $5496.9400 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 154 177 288.491998 $6069.8800 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 2 2 1.872222 $114.2000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 8 9 21.991269 $1911.9200 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1082 1251 1354.455589 $101760.2400 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 94 111 111.968720 $5074.4100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 21 32 77.121699 $8931.4500 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 97 128 189.869559 $9493.4900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 19 23 34.118873 $1705.9500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 294 305 369.712093 $18485.6200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 55 72 142.159381 $10661.9500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 81 83 151.055402 $11329.1600 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 37 38 70.005479 $5250.4100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 14 14 28.000000 $2100.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 13 13 23.511111 $1763.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 39 39 77.000000 $5775.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 20 20 34.005479 $2550.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 33 43 80.505479 $6037.9100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 14 17 32.000000 $2400.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 105 106 183.291171 $10172.6600 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 29 29 50.159056 $2783.8200 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 3 3 5.000000 $277.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1338 1362 2625.630119 $196922.3300 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 613 625 1183.321025 $88749.0800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 363 366 706.566667 $52992.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 199 203 396.505479 $29737.9100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 479 483 946.685714 $71001.4300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 305 308 564.052129 $42303.9200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1882 1942 3729.905797 $207009.8300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 793 812 1527.855706 $84795.9900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1020 1276 2484.006196 $186300.4700 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 373 453 898.500000 $67387.5100 $75.0000
MED -99202 OUTPATIENT VISIT, NEW, 20 MINS 2 4 4.406348 $238.6900 $54.1700
MED -99204 OUTPATIENT VISIT, NEW, 45 MINS 1 1 1.911111 $296.1800 $154.9800
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 33 62 152.122217 $21636.2700 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 14 16 131.552382 $6577.6200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 39 53 488.890479 $24444.5300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 280 438 342.438973 $17604.8200 $51.4100
OCTF -97168GT OT RE-EVAL EST PLAN CARE 5 5 3.166667 $162.8000 $51.4100
OCTF -97168TL OT RE-EVAL EST PLAN CARE 2 2 1.350000 $69.4000 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 3 3.027778 $155.6600 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 661 859 930.842240 $47854.6200 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 4 4 2.199999 $113.1000 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 20 21 13.994446 $719.4600 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 140 168 148.175360 $7617.7300 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 15 19 60.230888 $3096.4700 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 10 10 5.781354 $297.2200 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 4 5 26.198043 $1346.8400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 524 616 583.569013 $30001.3000 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 25 30 25.000001 $1285.2600 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 81 112 65.270121 $3355.5300 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 9 10 28.956350 $1488.6500 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 166 276 246.128688 $12653.5100 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 5 8 5.505556 $283.0400 $51.4100
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 1 0.672222 $34.5600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 244 336 310.274116 $15951.2100 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 4 4 3.501370 $180.0100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 13 15 32.069842 $1648.7100 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 80 106 88.466344 $4548.0700 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 10 13 8.520549 $438.0300 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 4 4 2.638889 $135.6700 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 325 433 330.782880 $17005.5600 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 15 16 15.379072 $790.6400 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 56 80 77.925689 $4006.1600 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 2 2 2.044444 $105.1000 $51.4100
SCREEN-T1023 SCREENING 158 168 170.187823 $8509.3900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 6 15.682648 $236.9600 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 749 1037 1091.144403 $56095.8200 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 17 18 15.405555 $792.0000 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 62 97 81.990476 $4215.1400 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 5 6 4.149999 $213.3500 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 48 57 61.026103 $3137.3500 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 9 10 11.162404 $573.8500 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 13 14 11.233943 $577.5400 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 0.533333 $27.4200 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 817 1181 848.860470 $43640.0400 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 30 38 33.619797 $1728.3900 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 23 33 24.255556 $1246.9800 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 11 14 10.584170 $544.1300 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 13 14 11.683334 $600.6400 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 66 85 55.604491 $2858.6300 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 8 4.077093 $209.6000 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 1.584932 $81.4800 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 41 57 715.823808 $36800.4900 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 3 4 62.571429 $3216.8000 $51.4100
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Subtotal (Total Children Is Unduplicated) 9517 19970 29932.699490 $1754786.9300 $58.6200
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 2 2 2.177778 $92.3600 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 345 479 992.097444 $4960489.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 49 55 308.089909 $15404.4900 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 9 12 227.070635 $15747.3500 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 11 13 22.772994 $1579.3100 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 94 114 216.706151 $50193.4200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 3101 4797 4877.346956 $243867.9500 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 250 328 246.056680 $12302.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 852 1113 1098.215259 $27455.4000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4659 7641 27010.632577 $1350531.7400 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 255 365 1195.340477 $59767.0200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 327 483 1331.705917 $33292.6600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3955 6237 16405.280260 $820263.9900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 211 271 706.849203 $35342.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 184 435 1017.721818 $25443.0300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1669 2854 8638.872189 $431943.6900 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 119 178 428.520201 $21426.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 69 193 522.366668 $13059.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5104 7650 20109.262655 $1005463.1200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 266 351 947.878575 $47393.9600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 334 473 1353.105164 $33827.6400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 63 96 3762.457139 $94061.4400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 397 955 11495.558714 $287388.9800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 967 1188 16547.121426 $827356.1500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 16210 28419 396089.953613 $19804499.2800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2258 3291 48766.002333 $2438300.3600 $50.0000
INTR -T1013 INTERPRETER 674 1025 4769.397267 $238469.8500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8844 19423 228910.337181 $2746924.2200 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 2439 4263 54994.771778 $3957424.2700 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 69 93 1221.424598 $87893.7100 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 342 552 8855.674187 $510086.8700 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 17 22 249.178570 $14352.6900 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 283 421 4958.928568 $356844.5200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 19 21 177.330951 $12760.7300 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 16.733334 $963.8400 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 2 3 136.571428 $7866.5200 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 2018 3919 48592.280318 $3496700.8100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 54 70 780.367462 $56155.2200 $71.9600
PHY -97110HM PT SESSION BY PT ASST 155 301 4210.603960 $242362.4200 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 9 15 142.873812 $8223.8200 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 240 377 4099.201585 $294978.5900 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 32 43 471.998412 $33965.0200 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 1 36.000000 $2072.1600 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 1 1 16.285714 $937.4000 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 7 11 10.510805 $1206.7500 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 5 7 5.913851 $1357.8700 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 9 13 17.453424 $4007.4800 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 18 26 30.233333 $13883.7400 $459.2200
SENS -V5264 EARMOLD 56 98 202.889950 $3678.3900 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3491 6079 78971.924242 $5682820.2100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 120 173 2244.107137 $161485.9800 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 18 210.235713 $12109.5800 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 2 3 39.571429 $2279.3100 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 293 473 5296.825392 $381159.5900 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 46 56 460.685715 $33150.9500 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 21 37 301.447619 $4208.2100 $13.9600
TRAV -TRAVS Travel by mile 3397 8387 1156053.384777 $514443.7600 $0.4500
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Subtotal (Total Children Is Unduplicated) 22649 113926 2170804.305247 $51541267.2300 $23.7400
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Total 135881 2359854.042031 $58732836.9400 $24.8900
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Number of Children (Unduplicated) With at Least One Authorization 24516