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
Eligibility Filter: Program Patients
With the filters selected there were 203820 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 0.175000 $6.5100 $37.2000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 1883 2291 21753.018242 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 4 140.276190 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 408 455 166654.007932 $6199529.0800 $37.2000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2291 2752 188547.477364 $6199535.5900 $32.8800
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 721 1157 1257.473046 $60987.4200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 268 316 688.523548 $38626.1800 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 81 82 134.292586 $2127.1900 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1176 1396 1759.626980 $34330.3100 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 196 225 275.565078 $6522.6200 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 208 247 308.120874 $4523.2100 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 443 530 562.795455 $12420.9200 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 214 248 344.074601 $3031.3000 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 35 37 41.600000 $434.7200 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 262 310 404.324603 $11693.0700 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 47 63 101.018254 $4553.9000 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 275 337 534.301585 $7378.7000 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 284 333 513.041008 $10794.3900 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 5 6 8.044443 $490.7000 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 16 23 36.880157 $3206.3500 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 1640 1887 2050.371287 $154044.3800 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 186 221 223.853497 $10145.0300 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 63 83 120.136689 $13913.0100 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 1.428571 $178.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 138 183 288.013709 $14400.7000 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 26 30 43.129831 $2156.5000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 421 439 506.022326 $25301.1400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 92 123 242.716458 $18203.7300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 125 129 237.643225 $17823.2400 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 57 58 101.038659 $7577.9000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 26 26 51.000000 $3825.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 21 21 39.511111 $2963.3300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 61 61 120.500000 $9037.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 32 32 47.035920 $3527.6900 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 54 69 131.505479 $9862.9100 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 20 24 45.000000 $3375.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 165 169 301.791966 $16749.4500 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 55 59 94.217275 $5229.0500 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 6 6 7.285714 $404.3600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1978 2010 3894.662993 $292099.8100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 931 948 1783.051160 $133728.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 564 569 1102.852381 $82713.9300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 343 347 670.520547 $50289.0500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 721 725 1411.976984 $105898.2800 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 445 451 815.994595 $61199.5900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2796 2874 5542.316166 $307598.6100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 1220 1245 2349.158900 $130378.3100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1533 1949 3795.891910 $284691.9000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 542 651 1290.000000 $96750.0100 $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 64 122 349.788883 $49750.3900 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 22 25 175.312699 $8765.6400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 55 75 705.414287 $35270.7200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 459 718 583.550720 $30000.3900 $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 3 3 2.350000 $120.8100 $51.4100
OCTF -97168TLGT OT RE-EVAL EST PLAN CARE 2 3 3.027778 $155.6600 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 1126 1464 1527.184785 $78512.6400 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 8 8 4.593683 $236.1600 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 32 39 27.488889 $1413.2000 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 228 274 243.765802 $12532.0400 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 23 27 87.639498 $4505.5500 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 14 15 10.792465 $554.8400 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 7 9 27.935791 $1436.1800 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 824 968 948.397289 $48757.1600 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 38 44 49.284128 $2533.7100 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 134 184 106.847895 $5493.0200 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 12 13 32.678572 $1680.0100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 254 421 355.774201 $18290.4000 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 7 10 7.533334 $387.2900 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTF -97164TLGT PT RE-EVAL EST PLAN CARE 1 1 0.672222 $34.5600 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 429 584 583.698339 $30007.9600 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 9 13 10.540259 $541.8800 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 19 25 38.158729 $1961.7300 $51.4100
PSTH -97161TLGT PT EVAL LOW COMPLEXITY 1 1 0.364384 $18.7300 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 135 187 185.695384 $9546.6300 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 20 25 14.395968 $740.0900 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 5 5 3.638889 $187.0800 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 2 3 2.694445 $138.5200 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 515 696 544.411786 $27988.2000 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 24 26 22.526028 $1158.0700 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 108 154 191.688386 $9854.6900 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 4 4 4.044444 $207.9200 $51.4100
SCREEN-T1023 SCREENING 259 277 286.087823 $14304.3900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 9 15 30.950076 $467.6500 $15.1100
SPCH -92521 EVAL OF SPEECH FLUENCY 1454 2108 2141.563058 $110097.9000 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 27 30 24.635203 $1266.5000 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 123 180 129.987300 $6682.6500 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 7 8 5.511110 $283.3200 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 81 95 91.913242 $4725.2600 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 17 18 20.101293 $1033.4000 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 25 34 36.167276 $1859.3600 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 3 3 2.533333 $130.2400 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1386 2018 1517.332591 $78006.2400 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 46 56 70.722643 $3635.8400 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 30 42 30.022223 $1543.4500 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 15 19 14.778614 $759.7700 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 24 25 20.561111 $1057.0500 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 123 172 128.220914 $6591.8200 $51.4100
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 12 5.704871 $293.2900 $51.4100
SPCH -92610TLGT EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 1.584932 $81.4800 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 99 147 2092.738093 $107587.6800 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 8 9 102.142858 $5251.1600 $51.4100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 14979 32133 47900.142223 $2795059.5700 $58.3500
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 3 3 3.177778 $134.7700 $42.4100
ASST -ASST ASSISTIVE TECHNOLOGY 602 861 1670.126520 $8350635.0000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 93 107 394.889203 $19744.4500 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 14 21 300.180159 $20817.5100 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 14 17 25.817439 $1790.4500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 148 190 325.022709 $75281.7100 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4591 7120 7289.434019 $364472.5600 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 417 554 387.750118 $19387.5100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1350 1828 1803.341204 $45083.5700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6928 11370 39949.211567 $1997460.7800 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 392 551 2005.301587 $100265.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 468 702 1892.628936 $47315.7400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5738 9098 24366.644946 $1218332.1900 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 322 410 1088.715081 $54435.7400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 242 540 1287.786661 $32194.6600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2459 4219 13409.077759 $670454.0200 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 188 286 702.483693 $35124.1800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 97 248 638.477780 $15961.9500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7745 11775 31144.574556 $1557228.6800 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 408 543 1499.803178 $74990.1900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 500 714 2006.067876 $50151.7400 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 90 138 5539.457141 $138486.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 522 1263 16285.353938 $407133.8600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2009 2677 43040.975397 $2152048.8400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 2 2 36.571428 $1828.5800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 22671 39629 544364.098007 $27218207.5700 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 2898 4177 60983.247548 $3049162.7900 $50.0000
INTR -T1013 INTERPRETER 832 1244 5612.706788 $280635.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 12165 26870 315106.506510 $3781278.3900 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 4017 7044 89727.763408 $6456810.6600 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 112 148 1680.829360 $120952.4900 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 479 793 12902.622198 $743191.0700 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 27 35 346.571427 $19962.5200 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 360 544 6637.603175 $477641.9300 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 34 38 329.496824 $23710.5800 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 3 5 37.376191 $2152.8700 $57.6000
OCCT -97530TLHM OT SESSION BY OT ASST 2 3 136.571428 $7866.5200 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 3365 6584 80114.910863 $5765069.6100 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 96 126 1438.251586 $103496.5900 $71.9600
PHY -97110HM PT SESSION BY PT ASST 236 450 6173.308716 $355335.7100 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 15 23 256.623811 $14771.2700 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 317 503 5691.849207 $409585.5500 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 51 74 773.307144 $55647.1900 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 2 4 51.857143 $2984.8900 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 4 5 47.023810 $2706.6900 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 18 26 21.790561 $2501.7800 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 21 29 30.210654 $6936.6300 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 22 30 42.196498 $9688.7200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 45 65 89.505555 $41102.7200 $459.2200
SENS -V5264 EARMOLD 147 256 598.619322 $10852.9600 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 6752 12003 155199.575752 $11168162.5800 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 221 333 4006.916665 $288337.7400 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 19 27 270.128569 $15559.4200 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 4 5 62.000000 $3571.2000 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 383 630 7073.607932 $509016.8900 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 72 101 984.344445 $70833.4400 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 35 56 559.833333 $7815.2700 $13.9600
TRAV -TRAVS Travel by mile 4796 11838 1568679.552499 $698062.4100 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 33275 168935 3067123.677602 $79174372.0800 $25.8100
-------------------------------------------------------------------------------------------------------------------------------------
Total 203820 3303571.297189 $88168967.2400 $26.6900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 36163