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 43916 FSPSA's found of which 931 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 17 19 9.538889 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 33 43 168.127777 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 118 137 132.912355 $4917.7600 $37.0000
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Subtotal (Total Children Is Unduplicated) 168 200 310.721878 $4923.0400 $15.8400
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 185 232 219.255736 $10633.9400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 11 3.744444 $176.3200 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 45 45 11.219787 $167.5100 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 142 146 56.680919 $1088.3100 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 47 48 12.836455 $133.7600 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 0.364383 $8.0000 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 48 48 12.319711 $107.8000 $8.7500
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 49 49 12.758600 $278.6500 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.175342 $5.0700 $28.8900
AUDE -92585 AUD EVOKED RESPONSE (COMP) 35 35 11.533335 $751.2900 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 2.500000 $95.9300 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 45 45 12.180899 $278.9400 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 14 14 3.798401 $96.9700 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 12 10.437521 $488.4800 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 15 4.301597 $514.4600 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 6 7 1.334018 $166.7400 $124.9900
EVAL -96111 DEVELOPMENTAL EVALUATION 32 44 30.150372 $1507.5300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 552 625 702.210579 $35110.4400 $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 7 7 5.860654 $439.5500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 15 17 4.911039 $368.3600 $75.0100
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 2.942791 $220.7000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 10 11 8.658839 $649.4200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 21 23 5.963702 $331.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 83 83 42.091169 $3156.9100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 26 26 12.016237 $901.2400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 4.507172 $338.0500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 91 91 34.273888 $1902.2300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 23 24 18.764768 $1407.3800 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 1.714286 $85.7200 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.011111 $50.5600 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 3.033333 $151.6700 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 24 26 79.109237 $4038.5300 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 136 139 121.521588 $6203.7200 $51.0500
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 22 26 6.912721 $1036.9100 $150.0000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 39 40 70.755557 $3612.0900 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 102 110 77.360226 $3949.2700 $51.0500
SCREEN-T1023 SCREENING 69 73 59.228082 $2961.4100 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 1.306621 $20.3800 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 0.635008 $32.4200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 5 1.438204 $73.4200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 273 295 359.205546 $18337.5300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 28 29 72.037470 $3677.5300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.208220 $10.4200 $50.0200
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Subtotal (Total Children Is Unduplicated) 1705 2438 2104.452902 $105656.0300 $50.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 93 112 127.874559 $639377.5000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 15 16 17.049998 $852.4900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 153 160 139.830593 $6991.6100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.150000 $10.7400 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 9 12.450958 $891.6200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 15 15 8.983029 $2148.7300 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1310 1719 1305.093561 $65254.9600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 56 70 85.321062 $2133.0200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4682 9808 17058.511106 $852924.6300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 140 253 562.250663 $14056.2400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 264 320 435.246999 $21762.3200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 1.011111 $25.2800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 160 215 334.187226 $16709.3600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 590 690 813.362492 $40668.0300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 6 6 12.733332 $318.3300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 5.161904 $378.4700 $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 49 57 861.690475 $21542.2700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 8 155.142857 $7757.1500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 20 27 129.897619 $6494.8800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2528 3257 24573.101650 $1228655.1000 $50.0000
INTR -T1013 INTERPRETER 168 231 1498.042139 $74902.1300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7844 14820 79870.851163 $798708.4900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 447 563 4230.969736 $302260.5800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 37 40 253.740478 $14513.9600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 440 544 3702.281038 $264490.9700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 45 52 367.178571 $20987.9300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 22 22 7.032721 $457.1200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.088889 $10.5400 $118.5700
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 2.022222 $479.5000 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
4 4 0.906849 $215.0200 $237.1100
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 2 2 0.498630 $236.4600 $474.2100
SENS -V5264 EARMOLD 27 32 36.407379 $655.3300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1229 1506 11181.335985 $798794.6800 $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 59 62 711.547622 $9876.2800 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 1225 1879 7987.384022 $3993.6900 $0.5000
TRAV -TRAVS Travel by mile 2379 4770 320311.959285 $142538.8300 $0.4500
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Subtotal (Total Children Is Unduplicated) 12434 41278 476818.297923 $5362628.0300 $11.2500
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Total 43916 479233.472703 $5473207.1000 $11.4200
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Number of Children (Unduplicated) With at Least One Authorization 12748