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 68780 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 1288 1576 12408.057933 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 48.885714 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 22 28 5634.355555 $209598.0200 $37.2000
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Subtotal (Total Children Is Unduplicated) 1313 1607 18091.465869 $209604.2300 $11.5900
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 3.000000 $310.0800 $103.3600
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 444 686 754.345582 $36585.7700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 13 16 14.612939 $819.7900 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 3 3 14.450000 $228.8900 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 108 114 113.305556 $2210.5900 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 5 4.061111 $96.1300 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 6 5.061111 $74.3000 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 9 6.661110 $147.0100 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 6 7 5.555555 $48.9400 $8.8100
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 7 5.555555 $160.6700 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 1.061111 $47.8300 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 6 7.433332 $102.6500 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 9 9.489682 $199.6600 $21.0400
AUDE -92651 AEP HEARING STATUS DETER I&R 2 2 1.450000 $126.0600 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 71 79 79.000000 $5935.2700 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 5 7.144444 $323.7800 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 3 1.366667 $158.2800 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 94 124 183.902892 $9195.1500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 19 23 34.118873 $1705.9500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 277 287 356.281935 $17814.1100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 5 9.000000 $675.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 13 13 24.500000 $1837.5000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 4 4 8.000000 $600.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 9.000000 $675.0000 $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 4 6 12.000000 $900.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 1 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 12.000000 $666.0000 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 74 74 144.291193 $10821.8400 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 19 20 40.000000 $3000.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 18 18 36.000000 $2700.0000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 7 7 14.000000 $1050.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 51 51 99.785714 $7483.9300 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 29 29 57.000000 $4275.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 90 90 177.005479 $9823.8100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 25 26 52.000000 $2886.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 52 61 119.000000 $8925.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 22 25 50.000000 $3750.0000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 1 2 2.411111 $342.9300 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 8 10 45.009524 $2250.4800 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 17 20 141.042858 $7052.1600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 18 25 15.072223 $774.8700 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 79 92 85.188890 $4379.5700 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 2 2 1.111111 $57.1200 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 4 4 3.827778 $196.7900 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 23.285714 $1197.1200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 37 44 32.555556 $1673.6800 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 3 3 2.027778 $104.2500 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 4 5 2.883334 $148.2400 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 12 16 9.088889 $467.2600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 16 18 19.397621 $997.2400 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 2 2 0.916667 $47.1300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 6 4.616667 $237.3400 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 13 20 17.007935 $874.3700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 7 7 2.655556 $136.5200 $51.4100
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 106 131 137.876986 $7088.2700 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 1 2 2.000000 $102.8200 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 4 6 3.888890 $199.9300 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.761111 $39.1300 $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 -92522TL EVAL OF SPCH SOUND PROD 1 1 1.005556 $51.7000 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 37 45 25.111112 $1290.9700 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 1.000000 $51.4100 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 2 6 5.838889 $300.1800 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.4100 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 3.000000 $154.2300 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 2 3 18.614286 $956.9600 $51.4100
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Subtotal (Total Children Is Unduplicated) 1505 2328 3106.635883 $169436.6800 $54.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 77 88 124.658187 $623291.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 27 28 58.773233 $2938.6600 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 7 10 11.583333 $2682.9200 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 2898 4455 4539.416076 $226971.4100 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 249 327 244.056680 $12202.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 612 724 683.673463 $17091.8700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4585 7542 26909.304802 $1345465.3700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 255 365 1195.340477 $59767.0200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 324 475 1315.089252 $32877.2500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3910 6180 16316.305657 $815815.2600 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 210 270 705.515870 $35275.7800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 182 433 1015.744041 $25393.5900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1633 2808 8581.166633 $429058.4100 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 119 178 428.520201 $21426.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 67 191 511.766668 $12794.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 5039 7566 20008.978531 $1000448.9200 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 266 351 947.878575 $47393.9600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 326 463 1335.127387 $33378.2000 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 6 7 143.214285 $3580.3600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 21 24 154.571428 $3864.2800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 822 965 13544.561106 $677228.1200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 706 1000 13131.539286 $656577.0000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 70 91 1470.857147 $73542.8500 $50.0000
INTR -T1013 INTERPRETER 632 941 4499.297268 $224964.8400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8843 19414 228776.051467 $2745312.7900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 314 413 5726.336895 $412067.2500 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 3 3 12.990476 $934.7900 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 29 39 665.499998 $38332.7800 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 1 1 52.285714 $3011.6600 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 3 4 33.104762 $2382.2100 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 2 2 50.714286 $3649.4000 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 317 437 5536.848612 $398431.6500 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 5 5 80.142856 $5767.0800 $71.9600
PHY -97110HM PT SESSION BY PT ASST 12 18 265.142858 $15261.6200 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 1 1 6.535714 $376.1900 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 10 11 98.944444 $7120.0400 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 3 34.642857 $2492.9000 $71.9600
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 5 7.144444 $3280.8500 $459.2200
SENS -V5264 EARMOLD 4 9 10.655555 $193.1800 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 446 603 7784.535710 $560175.2100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 6 113.723810 $8183.5700 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 2.857143 $164.5700 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 6 9 98.085714 $7058.2500 $71.9600
TRAV -TRAVS Travel by mile 3397 8379 1155927.956206 $514387.9500 $0.4500
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Subtotal (Total Children Is Unduplicated) 16725 64845 1523161.139107 $11112614.0100 $7.3000
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Total 68780 1544359.240859 $11491654.9200 $7.4400
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Number of Children (Unduplicated) With at Least One Authorization 17735