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 114093 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 1791 2175 20461.837287 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 49.419047 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 99 110 24626.230159 $916095.7600 $37.2000
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Subtotal (Total Children Is Unduplicated) 1894 2290 45137.661493 $916102.2700 $20.3000
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 644 1016 1050.211501 $50935.2300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 65 74 107.995009 $6058.5100 $56.1000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 8 8 36.376985 $576.2100 $15.8400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 207 221 277.003967 $5404.3400 $19.5100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 22 26 27.077777 $640.9300 $23.6700
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 38 47.933333 $703.6600 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 31 40 40.483331 $893.4600 $22.0700
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 30 37 50.722222 $446.8600 $8.8100
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.000000 $10.4500 $10.4500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 33 43 55.383333 $1601.6900 $28.9200
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 8 12.927778 $582.7900 $45.0800
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 50 58 55.461112 $765.9200 $13.8100
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 44 52 72.767460 $1531.0300 $21.0400
AUDE -92650 AEP SCR AUDITORY POTENTIAL 1 2 1.638888 $99.9700 $61.0000
AUDE -92651 AEP HEARING STATUS DETER I&R 4 4 3.872222 $336.6500 $86.9400
AUDE -92652 AEP THRSHLD EST MLT FREQ I&R 175 191 240.285714 $18052.6600 $75.1300
AUDE -V5010 ASSESSMENT FOR HEARING AID 27 36 35.752738 $1620.3100 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 12 16 10.150532 $1175.5300 $115.8100
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 1.428571 $178.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 122 161 243.887519 $12194.3900 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 22 26 37.124352 $1856.2200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 386 400 474.806454 $23740.3400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 20 27 56.266667 $4220.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 28 28 49.087823 $3681.5900 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 12 12 16.033180 $1202.4900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 14.500000 $1087.5000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 18.500000 $1387.5000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 13 13 16.030441 $1202.2800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 13 26.000000 $1950.0000 $75.0000
IPDEF -T1024TLTSGT F/U PHYC AND DEV EVAL BY EI PROF 3 4 8.000000 $600.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 43 46 86.929366 $4824.5800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 19 22 29.058219 $1612.7300 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 2 2 2.000000 $111.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 279 282 545.318588 $40898.9000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 191 195 352.230135 $26417.2600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 90 91 175.500000 $13162.5000 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 70 70 131.515068 $9863.6300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 137 137 257.291270 $19296.8500 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 114 117 204.942466 $15370.6700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 568 576 1109.130134 $61556.7300 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 277 281 525.303194 $29154.3200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 153 178 349.500000 $26212.5000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 69 82 161.500000 $12112.5000 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 4 6 28.811111 $4097.8000 $142.2300
NUTR -97802 NUTRITIONAL EVAL, INITIAL 15 18 79.126984 $3956.3600 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 21 24 176.176192 $8808.8300 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 75 103 86.463059 $4445.0700 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 287 346 372.019050 $19125.5200 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 1 1 0.288889 $14.8500 $51.4100
OCTH -97165TL OT EVAL LOW COMPLEXITY 4 5 3.888889 $199.9300 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 32 36 28.963243 $1489.0000 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 4 23.408610 $1203.4400 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.011111 $51.9800 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 1 1 23.285714 $1197.1200 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 116 127 166.231598 $8545.9800 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 7 8 4.850000 $249.3400 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 23 26 14.822222 $762.0100 $51.4100
OCTH -97167TLGT OT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 46 67 43.361112 $2229.2000 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 1.011111 $51.9800 $51.4100
PSTF -97164TL PT RE-EVAL EST PLAN CARE 1 1 0.200000 $10.2800 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 75 91 111.428791 $5728.5600 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 2 5 3.588889 $184.5100 $51.4100
PSTH -97161TL PT EVAL LOW COMPLEXITY 3 3 1.277778 $65.6900 $51.4100
PSTH -97162 PT EVAL MODERATE COMPLEXITY 16 26 16.435085 $844.9300 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 4 4 4.000000 $205.6400 $51.4100
PSTH -97162TL PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97162TLGT PT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 75 99 70.069044 $3602.2300 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 2 2 1.109818 $57.0600 $51.4100
PSTH -97163TL PT EVAL HIGH COMPLEXITY 30 35 39.692859 $2040.6200 $51.4100
PSTH -97163TLGT PT EVAL HIGH COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
SCREEN-T1023 SCREENING 13 13 13.000000 $650.0000 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 392 525 588.862628 $30273.4700 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 6 7 5.310926 $273.0300 $51.4100
SPCH -92521TL EVAL OF SPEECH FLUENCY 31 38 23.074603 $1186.2700 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.761111 $39.1300 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 5.128844 $263.6800 $51.4100
SPCH -92522GT EVAL OF SPCH SOUND PROD 3 3 4.000000 $205.6400 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 5 6 16.966668 $872.2600 $51.4100
SPCH -92522TLGT EVAL OF SPCH SOUND PROD 1 1 1.000000 $51.4100 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 190 263 245.986414 $12646.1800 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 8 10 7.856163 $403.8800 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 4 8 7.838889 $403.0000 $51.4100
SPCH -92523TLGT EVAL OF SPCH SOUND PROD; EVAL LANG 1 2 1.766666 $90.8200 $51.4100
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 4 4 3.522222 $181.0800 $51.4100
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 11 15 11.338889 $582.9300 $51.4100
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 8 10 86.757143 $4460.1800 $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) 3861 6615 9357.619674 $528099.2600 $56.4400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 213 267 421.368562 $2106843.5000 $5000.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 38 40 85.176407 $4258.8200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 2.000000 $138.7000 $69.3500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 2.000000 $138.7000 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 25 33 54.465874 $12615.3900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 4234 6525 6552.782743 $327639.9900 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 416 551 385.744638 $19287.2400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 907 1078 996.542350 $24913.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 6796 11193 39760.106014 $1988005.5200 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 391 550 2003.246031 $100162.2800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 464 692 1868.312271 $46707.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 5640 8973 24199.309231 $1209965.4000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 321 409 1087.381748 $54369.0800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 240 538 1285.808884 $32145.2200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2389 4132 13279.849980 $663992.6300 $50.0000
CONPF -CONPFGT CONSULT, PT, TELEMEDICINE 188 284 691.674169 $34583.7000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 93 241 613.788891 $15344.7300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 7613 11606 30930.809479 $1546540.4400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 408 542 1491.088892 $74554.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 490 698 1967.101210 $49177.5800 $25.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 10 11 183.214285 $4580.3600 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 72 83 423.938090 $10598.4500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1655 2141 36017.590073 $1800879.5100 $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 5317 8786 116823.792833 $5841190.3800 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 573 770 11026.167447 $551308.5200 $50.0000
INTR -T1013 INTERPRETER 770 1126 5290.106789 $264505.3200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 12162 26846 314690.220797 $3776282.9700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 889 1290 17067.909101 $1228206.8900 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 17 17 149.976587 $10792.3000 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 68 94 1626.115870 $93664.2500 $57.6000
OCCT -97530HMGT OT SESSION BY OT ASST 4 5 63.500000 $3657.6000 $57.6000
OCCT -97530TL OT SESSION BY LICENSED OT 29 35 401.422222 $28886.3400 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 9 10 122.826191 $8838.5800 $71.9600
OCCT -97530TLGTHM OT SESSION BY OT ASST 1 2 20.285714 $1168.4600 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 743 1121 13405.414880 $964653.7800 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 10 11 168.201585 $12103.7900 $71.9600
PHY -97110HM PT SESSION BY PT ASST 28 45 667.057144 $38395.8000 $57.5600
PHY -97110HMGT PT SESSION BY LICENSED PT ASST 3 4 33.214285 $1911.8200 $57.5600
PHY -97110TL PT SESSION BY LICENSED PT 35 41 451.801586 $32511.6400 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 6 8 72.513491 $5218.0700 $71.9600
PHY -97110TLGTHM PT SESSION BY PT ASST 1 2 14.000000 $805.8400 $57.5600
PHY -97110TLHM PT SESSION BY PT ASST 1 2 15.714286 $904.5200 $57.5600
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 2.011111 $230.8900 $114.8100
SENS -V5050 IN EAR MONAURAL HEARING AID 5 6 5.851141 $1343.4700 $229.6100
SENS -V5060 BEHIND EAR HEARING AID 4 6 12.111111 $2780.8300 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 10 15 19.227778 $8829.7900 $459.2200
SENS -V5264 EARMOLD 28 43 91.280590 $1654.9100 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1571 2373 30820.628545 $2217852.6600 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 40 56 522.992859 $37634.5900 $71.9600
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 11.000000 $633.6000 $57.6000
SPL -92507HMGT SPL THERAPY SESSION BY SLP ASST 1 1 14.142857 $814.6300 $57.6000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 34 45 624.366665 $44929.4600 $71.9600
SPL -92507TLGT SPL THERAPY SESSION BY LICENSED SLP 3 4 33.461905 $2407.9200 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 3 4 92.642858 $1293.2900 $13.9600
TRAV -TRAVS Travel by mile 4794 11823 1568482.981070 $697974.9400 $0.4500
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Subtotal (Total Children Is Unduplicated) 25598 105188 2247182.810548 $26012659.4900 $11.5800
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Total 114093 2301678.091715 $27456861.0300 $11.9300
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Number of Children (Unduplicated) With at Least One Authorization 27387