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
Eligibility Filter: Program Patients
With the filters selected there were 68332 FSPSA's found of which 2722 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 3 6 5.311111 $196.5100 $37.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 30 44 166.730954 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 269 291 1452.361779 $53737.3700 $37.0000
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Subtotal (Total Children Is Unduplicated) 300 341 1624.403844 $53933.8800 $33.2000
Screening, Eval, and Assessment, Class # 02
AACIO -92597GO AAC INITIAL EVAL BY LICENSED OT 1 1 0.005479 $0.5600 $103.0300
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 2 2 2.433333 $249.7300 $102.6300
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 124 149 232.999663 $11300.5000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 27 30 11.668644 $549.4700 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 291 293 222.492759 $3321.8000 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 304 321 248.426164 $4769.7700 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 294 298 229.819243 $2394.7100 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 19 21 100.964844 $2216.1800 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 312 316 236.339335 $2067.9600 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 5 5 92.250000 $743.5400 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 315 323 241.603109 $5276.5900 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 5 94.352055 $2726.7800 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 159 161 162.087984 $10558.4000 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.511111 $19.6100 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 296 299 129.152425 $2957.5800 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 16 18 104.659436 $2671.9500 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 50 55 109.174515 $5109.3600 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 71 81 54.339022 $6498.9900 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 3 3 0.446804 $55.8500 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 27 36 36.136530 $1806.8200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 472 514 588.095644 $29404.8000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 1.302588 $97.7000 $75.0000
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 40 44 91.461485 $6859.6100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 60 65 403.034263 $30227.5600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 8.901142 $667.5800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 68 101 167.434713 $12557.5700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 73 78 65.995782 $3662.7500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 491 496 291.862968 $21890.2200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 190 193 112.279640 $8421.1600 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 110 112 41.972579 $3148.0300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 435 442 428.028766 $23755.7200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 246 273 179.618617 $13471.5400 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 12.571429 $628.5700 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 3 3.166666 $158.3300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 15 80.307936 $4015.4000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 101 117 151.755356 $7747.1000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 456 478 322.905343 $16484.3600 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 92 101 76.790933 $11518.7100 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 163 184 126.059340 $6435.3200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 303 316 427.331227 $21815.2500 $51.0500
SCREEN-T1023 SCREENING 81 84 39.594901 $1979.7500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 6 2.862937 $44.6600 $15.6000
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 729 804 881.062201 $44978.2500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 31 32 113.585921 $5798.5700 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 3 3 0.695891 $34.8000 $50.0100
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Subtotal (Total Children Is Unduplicated) 3600 6899 6929.614619 $341155.5200 $49.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 160 186 234.669246 $1173353.0000 $5000.0300
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 22 23 34.522688 $1726.1300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 128 134 183.155739 $9157.8000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 3 4.030159 $288.6000 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 15 15 19.096727 $1367.5100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 11 11 2.093227 $500.7400 $239.2200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1231 1504 851.935421 $42596.8500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 58 72 28.226734 $705.6800 $25.0000
CONIF -CONIF CONSULT, FACE TO FACE 3394 7080 13236.439214 $661822.7000 $50.0000
CONIP -CONIP CONSULT, PHONE 108 203 300.351402 $7508.8000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 10.082540 $739.2500 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 6 6 215.857145 $5396.4300 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 447 520 6947.186340 $173679.7900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 6 264.946032 $13247.3000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 16 20 97.607142 $4880.3600 $50.0000
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 3 3 2.213699 $110.6900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11565 14812 116973.632004 $5848688.8500 $50.0000
INTR -T1013 INTERPRETER 203 253 2451.362429 $122568.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8229 14526 80620.493565 $806205.7500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1826 2291 16818.953617 $1201546.7100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 170 191 1265.746034 $72400.6800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2238 2878 20125.156114 $1437741.7200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 165 183 1036.491668 $59245.8800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 16 16 7.193302 $467.5700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 6 2.133104 $252.8900 $118.5500
SENS -V5050 IN EAR MONAURAL HEARING AID 31 32 87.222562 $20682.3200 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
2 2 0.298174 $70.7100 $237.1400
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 11 11 2.298707 $1090.2300 $474.2800
SENS -V5264 EARMOLD 127 152 391.401805 $7045.2400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4112 5157 39359.176767 $2811822.1500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 10 10 74.357143 $4253.2400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 126 129 1121.100794 $15560.8800 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 4416 6695 49403.238313 $24701.5600 $0.5000
TRAV -TRAVS Travel by mile 2089 3959 198418.500274 $88296.2500 $0.4500
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Subtotal (Total Children Is Unduplicated) 16210 61092 550591.169831 $14619722.4400 $26.5500
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Total 68332 559145.188294 $15014811.8400 $26.8500
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Number of Children (Unduplicated) With at Least One Authorization 16677