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: 10-01-15 and 12-31-15 Date of Report: 02-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 26050 FSPSA's found of which 1664 had no frequency modifier field, FORCE FREQ MODIFIER to 0
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 3 3.000000 $111.0000 $37.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 23 32 125.676986 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 115 121 632.082940 $23387.0600 $37.0000
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Subtotal (Total Children Is Unduplicated) 139 156 760.759926 $23498.0600 $30.8900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 79 98 112.125494 $5438.0900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 4.327777 $203.7900 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 51 51 115.194443 $1719.8500 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 55 56 114.922221 $2206.5000 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 51 52 115.705554 $1205.6500 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 91.000000 $1997.4500 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 51 52 115.317655 $1009.0300 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 91.205556 $735.1200 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 52 52 115.323210 $2518.6600 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 91.000000 $2629.9000 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 29 29 104.472221 $6805.3100 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 49 49 23.300988 $533.5900 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 92.246499 $2355.0500 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.648097 $30.3300 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 2.442922 $292.1800 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 0.145205 $18.1500 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 17 24 30.158600 $1507.9300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 325 355 446.664414 $22333.2300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.010959 $0.8300 $75.2800
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 0.283333 $15.7200 $55.4900
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 3.116666 $233.7500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 5.066667 $380.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 10 3.705478 $277.9100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 7 7 1.552359 $86.1600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 13 2.717956 $203.8700 $75.0100
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 0.010958 $0.8300 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 5.554791 $308.3000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 6 3.760274 $282.0200 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 12.571429 $628.5700 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 13 14 12.209567 $623.3000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 39 41 23.743387 $1212.0900 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 57 62 57.185822 $8577.9200 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 18 19 8.386060 $428.1000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 20 20 78.184320 $3991.3000 $51.0500
SCREEN-T1023 SCREENING 18 19 11.204110 $560.2100 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.200000 $10.2100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.590563 $30.1500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 72 77 81.283639 $4149.5500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 6 6 27.168624 $1386.9600 $51.0500
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Subtotal (Total Children Is Unduplicated) 738 1171 2004.713297 $76927.9500 $38.3700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 16 16 5.235084 $26176.0000 $5000.1100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 6.506349 $325.3200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 65 68 83.429352 $4171.4600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 10.444444 $747.9200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 1 1 0.065753 $15.7400 $239.3700
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 753 924 616.699619 $30835.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 14 18 13.792660 $344.8200 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 2306 4631 8160.296079 $408015.3000 $50.0000
CONIP -CONIP CONSULT, PHONE 68 133 214.355953 $5358.9100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 3.511111 $257.4300 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 9.571429 $239.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 18 18 407.233351 $10180.8400 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 8 10 52.766666 $2638.3300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 515 577 4285.126578 $214256.5900 $50.0000
INTR -T1013 INTERPRETER 180 227 2359.480481 $117974.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5991 10491 58510.744754 $585107.9900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 164 192 1509.000790 $107803.0900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 14 16 91.885715 $5255.8700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 185 224 1442.886517 $103079.8300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 13 14 121.642856 $6953.1100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 11 11 6.667275 $433.3700 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.416438 $98.7600 $237.1600
SENS -V5060 BEHIND EAR HEARING AID
1 1 0.131507 $31.1800 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 0.128767 $61.0800 $474.3600
SENS -V5264 EARMOLD 6 7 95.777777 $1724.0000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 400 470 3414.518025 $243933.3400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 3.428571 $196.1200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 18 18 185.503174 $2574.7800 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 2475 3802 27286.285877 $13643.1200 $0.5000
TRAV -TRAVS Travel by mile 1532 2838 143242.601626 $63742.9700 $0.4500
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Subtotal (Total Children Is Unduplicated) 9091 24723 252140.134578 $1956175.6500 $7.7600
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Total 26050 254905.607801 $2056601.6600 $8.0700
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Number of Children (Unduplicated) With at Least One Authorization 9280