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
Eligibility Filter: Program Patients
With the filters selected there were 73521 FSPSA's found of which 1062 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 19 21 12.950000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 34 45 180.261111 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 228 259 243.372513 $9004.7800 $37.0000
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Subtotal (Total Children Is Unduplicated) 279 326 436.726481 $9010.0700 $20.6300
Screening, Eval, and Assessment, Class # 02
AACIS -92597 AAC INTIAL EVAL BY LICENSED SLP 1 1 0.505556 $51.8900 $102.6400
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 212 271 343.076208 $16639.2400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 35 35 11.831281 $557.1400 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 172 175 45.314271 $676.5400 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 537 565 251.765736 $4834.0800 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 177 179 54.375458 $566.5900 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 34 37 11.661950 $255.9800 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 192 194 56.456657 $493.9900 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.200000 $1.6100 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 194 198 62.555973 $1366.2200 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 1.902435 $54.9800 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 113 115 32.810009 $2137.2600 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 3.005556 $115.3200 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 179 181 45.375837 $1039.1100 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 19 20 9.972145 $254.5900 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 58 61 58.071011 $2717.7400 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 71 84 50.894212 $6086.9000 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 6 7 1.334018 $166.7400 $124.9900
EVAL -96111 DEVELOPMENTAL EVALUATION 38 52 34.561329 $1728.0800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 554 628 715.731127 $35786.4700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 5 5.377777 $403.3300 $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 54 59 42.234401 $3167.6300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 73 93 222.511345 $16688.4200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 22 22 7.108578 $533.1500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 77 95 85.586748 $6419.0200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 124 149 121.819978 $6761.0600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 680 682 534.242304 $40068.8000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 192 193 123.505517 $9263.0900 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 160 160 39.641373 $2973.2500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 574 578 734.894849 $40786.8400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 311 338 298.931353 $22420.0200 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 1.714286 $85.7200 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 1.311111 $65.5600 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 20 30 96.855552 $4842.7800 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 104 114 137.105059 $6999.2600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 548 590 410.077406 $20934.6400 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 23 27 6.912721 $1036.9100 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 149 162 130.534711 $6663.8400 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 447 481 509.756539 $26023.1800 $51.0500
SCREEN-T1023 SCREENING 138 145 83.696656 $4184.8700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 7 2.287899 $35.6900 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 0.906926 $46.3000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 9 10 2.764384 $141.1200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 886 954 968.050085 $49419.1400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 70 72 105.286700 $5374.9200 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 5 5 0.463014 $23.1600 $50.0100
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Subtotal (Total Children Is Unduplicated) 4491 7792 6465.655819 $350929.7500 $54.2800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 255 324 407.949540 $2039756.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 27 31 26.798399 $1339.9100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 211 224 186.905842 $9345.3800 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.150000 $10.7400 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 20 20 21.161462 $1515.3800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 40 41 16.988357 $4063.6700 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1485 1926 1355.131757 $67756.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 128 152 103.232737 $2580.8100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4926 10433 18286.441437 $914321.1800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 149 266 576.551023 $14413.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 292 351 482.337474 $24116.8300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.011111 $25.2800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 186 243 372.614210 $18630.7000 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 625 726 860.898207 $43044.8100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 7 7 14.447618 $361.1900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 6.571428 $481.8200 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 5 6 138.142857 $3453.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 456 591 7536.642951 $188416.1000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 9 169.714286 $8485.7200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 26 34 156.412013 $7820.6000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11784 15784 116550.608789 $5827530.7900 $50.0000
INTR -T1013 INTERPRETER 168 231 1498.042139 $74902.1300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7876 14931 80267.978941 $802679.7700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1976 2522 17378.546602 $1241523.6200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 203 252 1536.140477 $87867.2500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2234 2985 19484.352175 $1391962.1500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 183 220 1281.512909 $73251.3000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 29 29 9.118642 $592.7100 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 5 1.729871 $205.1000 $118.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 36 40 17.516360 $4153.4700 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
6 6 2.134398 $506.0900 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 14 14 4.143149 $1964.8700 $474.2500
SENS -V5264 EARMOLD 125 155 154.228325 $2776.1000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4126 5333 38528.713548 $2752491.7000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 11 12 72.428572 $4142.9100 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 164 170 1648.559526 $22882.0000 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 1703 2529 11233.792723 $5616.8900 $0.5000
TRAV -TRAVS Travel by mile 2389 4794 321029.602143 $142858.1800 $0.4500
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Subtotal (Total Children Is Unduplicated) 16269 65403 641419.251998 $15787847.2900 $24.6100
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Total 73521 648321.634298 $16147787.1200 $24.9100
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Number of Children (Unduplicated) With at Least One Authorization 16751