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 28842 FSPSA's found of which 647 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 13 15 8.294444 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 24 32 138.600398 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 82 100 86.433786 $3198.0500 $37.0000
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Subtotal (Total Children Is Unduplicated) 119 148 233.471485 $3203.3400 $13.7200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 135 169 194.825673 $9449.0700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 2.944444 $138.6500 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 38 38 10.233333 $152.7800 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 97 100 39.372235 $755.9700 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 40 41 11.494445 $119.7700 $10.4200
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 38 38 10.750000 $94.0600 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 39 39 11.188889 $244.3700 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 25 25 7.327778 $477.3300 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 37 37 10.861112 $248.7200 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 8 2.783865 $71.0700 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.388889 $18.2000 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.255556 $150.1700 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 3 0.316895 $39.6000 $124.9600
EVAL -96111 DEVELOPMENTAL EVALUATION 29 40 29.778835 $1488.9600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 396 447 565.844818 $28292.2000 $50.0000
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 5 5 4.294444 $322.0800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 13 15 2.238893 $167.9500 $75.0100
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.415525 $31.1600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 6 5.105556 $382.9200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 15 17 4.889577 $271.3900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 28 28 7.839890 $588.0200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 7.307630 $548.0800 $75.0000
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 16 16 9.085384 $504.2400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 10 2.572599 $192.9500 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.714286 $35.7200 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 11 12 14.026300 $716.0400 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 44 45 36.284141 $1852.3200 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 14 17 6.005872 $900.8700 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 17 18 10.788096 $550.7400 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 30 32 28.492479 $1454.5600 $51.0500
SCREEN-T1023 SCREENING 34 37 26.477931 $1323.9000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.172222 $2.6900 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 0.635008 $32.4200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 4 0.932648 $47.6100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 71 75 101.459915 $5179.5300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 9 9 40.480953 $2066.5600 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.024658 $1.2400 $50.0900
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Subtotal (Total Children Is Unduplicated) 922 1361 1210.299510 $58952.3400 $48.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 32 38 32.508647 $162545.0000 $5000.0500
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 8 11.650000 $582.5000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 126 130 109.377712 $5468.9500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 6.927778 $496.1000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 3 3 1.032649 $247.0200 $239.2100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 931 1227 990.366212 $49518.5200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 47 51.301257 $1282.5300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3452 7095 11701.974858 $585098.3900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 103 190 378.652327 $9466.2900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 182 219 277.597397 $13879.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.011111 $25.2800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 114 151 218.992780 $10949.6300 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 425 489 527.067260 $26353.3000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 5 5 12.199999 $305.0000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.733333 $127.0900 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 13.000000 $325.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 20 23 657.142856 $16428.5700 $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 15 19 88.888096 $4444.4100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 445 554 3477.249313 $173862.4500 $50.0000
INTR -T1013 INTERPRETER 151 211 1432.487509 $71624.4000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5889 11033 59482.054186 $594820.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 168 197 1470.303566 $105038.5100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 15 15 99.150000 $5671.3900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 152 187 1221.405557 $87257.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 20 21 168.085714 $9607.7900 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 17 17 6.577927 $427.5600 $65.0000
SENS -V5060 BEHIND EAR HEARING AID
3 3 0.731507 $173.4500 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 0.498630 $236.4600 $474.2100
SENS -V5264 EARMOLD 6 8 7.377777 $132.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 388 450 3198.206992 $228479.9200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 4.000000 $228.8000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 21 23 228.798413 $3175.7200 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 908 1392 5993.110508 $2996.5500 $0.5000
TRAV -TRAVS Travel by mile 1809 3567 235943.655924 $104994.9300 $0.4500
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Subtotal (Total Children Is Unduplicated) 8744 27333 327823.403509 $2276686.1500 $6.9400
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Total 28842 329267.174504 $2338841.8400 $7.1000
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Number of Children (Unduplicated) With at Least One Authorization 8951