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: 01-01-16 and 03-31-16 Date of Report: 05-12-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 52294 FSPSA's found of which 729 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 1 0.142857 $5.2900 $37.0100
SCONLY-SCONLY *SERVICE COORDINATION ONLY 15 17 11.705555 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 24 32 138.600398 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 186 215 193.271722 $7151.0600 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 223 265 343.720532 $7156.3400 $20.8200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 145 183 208.654516 $10119.7700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 23 23 7.918267 $372.8800 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 129 131 34.658332 $517.4500 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 378 398 181.108398 $3477.4000 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 134 135 38.345927 $399.5600 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 19 20 7.581356 $166.4100 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 143 144 39.745773 $347.7700 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.200000 $1.6100 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 142 144 39.545773 $863.6700 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.011111 $29.2200 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 82 83 23.187784 $1510.4500 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.505556 $19.4000 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 135 136 34.570432 $791.6600 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 9 2.824961 $72.1200 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 29 30 38.217996 $1788.6100 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 39 47 37.361946 $4468.4500 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 3 0.316895 $39.6000 $124.9600
EVAL -96111 DEVELOPMENTAL EVALUATION 30 41 30.069246 $1503.4800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 396 447 565.844818 $28292.2000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 3.894444 $292.0800 $75.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 0.677778 $37.6200 $55.5000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 48 53 36.790489 $2759.3300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 66 86 214.872532 $16115.5100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 19 19 4.581312 $343.6100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 63 77 64.195370 $4814.6600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 111 135 110.284742 $6120.8600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 524 526 443.797112 $33285.2600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 149 150 106.860513 $8014.6700 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 120 120 22.038318 $1652.9900 $75.0100
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 434 437 636.402612 $35320.4800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 244 265 255.067958 $19130.2600 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.714286 $35.7200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 13 56.474601 $2823.7400 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 71 77 47.275261 $2413.4300 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 335 371 227.170173 $11597.1400 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 15 18 6.005872 $900.8700 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 96 107 49.912836 $2548.0800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 294 320 377.895404 $19291.6300 $51.0500
SCREEN-T1023 SCREENING 88 93 47.747494 $2387.4000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 0.904185 $14.1000 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 0.906926 $46.3000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 6 1.046499 $53.4200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 500 532 515.725328 $26327.8400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 36 36 47.394360 $2419.5000 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 4 4 0.279452 $13.9800 $50.0100
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 3061 5437 4570.584944 $253542.1600 $55.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 159 201 206.389411 $1031952.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 11 13 14.827778 $741.3900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 144 152 130.034105 $6501.7700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 9 11.183410 $800.8400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 18 19 5.434932 $1300.0500 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1035 1350 1017.707364 $50885.5600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 93 111 68.139145 $1703.4700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3569 7367 12229.866843 $611493.0100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 110 199 386.874909 $9671.8500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 198 236 300.768031 $15038.3600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.011111 $25.2800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 131 170 235.348335 $11767.4000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 444 508 547.973608 $27398.6100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 13.914285 $347.8600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 3.142857 $230.4400 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 5 86.142857 $2153.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 342 448 5789.600025 $144740.0200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 8.285714 $414.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 18 23 109.415189 $5470.7600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8983 12040 88540.189800 $4427009.7300 $50.0000
INTR -T1013 INTERPRETER 151 211 1432.487509 $71624.4000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5907 11094 59619.058154 $596190.5800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1254 1581 10831.509683 $773803.1600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 139 178 1051.609526 $60152.0600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1448 1916 12605.223566 $900517.1800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 124 145 877.282752 $50145.4800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 19 19 7.277242 $473.0100 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.296538 $153.7200 $118.5700
SENS -V5050 IN EAR MONAURAL HEARING AID 21 22 11.400760 $2703.3300 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
4 4 0.947945 $224.7700 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 6 6 1.185235 $562.0700 $474.2300
SENS -V5264 EARMOLD 62 78 73.928307 $1330.7000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2304 2971 21085.260766 $1506331.2000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 9 57.928572 $3313.5100 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 92 97 861.738889 $11960.9300 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 1238 1816 8207.198589 $4103.6000 $0.5000
TRAV -TRAVS Travel by mile 1811 3578 236393.513067 $105195.1200 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 11668 46592 462825.096809 $10438431.0700 $22.5500
-------------------------------------------------------------------------------------------------------------------------------------
Total 52294 467739.402285 $10699129.5800 $22.8700
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 12026