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: 07-01-16 and 09-30-16 Date of Report: 10-26-16 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 56387 FSPSA's found
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 0.577778 $21.3800 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 279 311 523.614548 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 19 20 104.805556 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 48 53 53.877777 $1993.4700 $37.0000
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Subtotal (Total Children Is Unduplicated) 343 385 682.875659 $2014.8500 $2.9500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 210 281 161.646096 $7839.9100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 31 31 37.511575 $1766.4100 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 7 8 5.018722 $74.9300 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 519 542 260.022202 $4992.3800 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 11 11 11.318722 $117.9400 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 89 90 58.356598 $1280.9200 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 26 27 23.102861 $202.1500 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 2.000000 $16.1200 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 30 31 23.518733 $513.6600 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $57.8000 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 37 38 18.185388 $1184.6000 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 3.000000 $115.1100 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 19 20 4.792543 $109.7600 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 29 30 13.537290 $345.6000 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 25 27 18.883996 $883.7700 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 37 43 22.290029 $2665.8500 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 2.866667 $358.3400 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 40 47 67.679882 $3384.0200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 402 438 481.518924 $24075.9300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 7 2.766209 $207.4600 $75.0000
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 0.355556 $19.7400 $55.5100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 59 70 67.057809 $5029.3100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 56 78 66.025867 $4951.9100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 13 10.437899 $782.8400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 51 60 49.633254 $3722.4800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 101 139 110.712104 $6144.4600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 501 503 706.458423 $52984.7300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 194 194 232.656275 $17449.4000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 122 122 106.858877 $8014.5100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 459 462 841.671437 $46712.8300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 187 199 288.771508 $21657.8800 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 14.142857 $707.1500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 22 26 108.885715 $5444.3000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 58 65 40.984767 $2092.2700 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 466 501 372.470106 $19014.6400 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 71 80 74.144338 $3785.0700 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 398 445 380.338070 $19416.2900 $51.0500
SCREEN-T1023 SCREENING 66 67 36.685923 $1834.3100 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.894977 $13.9600 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 5.145205 $262.6600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 3.280671 $167.4800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 556 612 424.988701 $21695.6900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 57 58 44.923006 $2293.3200 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 5 5 2.795738 $139.7900 $50.0000
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Subtotal (Total Children Is Unduplicated) 3494 5395 5210.335520 $294529.6500 $56.5300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 229 287 310.137781 $1550698.5000 $5000.0300
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 12 9.016666 $450.8300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 136 147 640.558530 $32027.9000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 12 12 25.036508 $1792.8600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 34 36 23.441846 $5607.2800 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1080 1366 1248.401713 $62420.1400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 92 107 116.526705 $2913.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3907 6170 10160.924587 $508046.4900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 228 307 1175.696818 $29392.4600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 953 1207 2019.735806 $100986.8300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 42 47 92.911110 $2322.7800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 874 1054 1733.049227 $86652.5100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 22 24 50.307937 $1257.7000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2398 2861 4107.282998 $205364.0300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 133 153 616.404782 $15410.1500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 19 24 84.457936 $6192.4600 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 2 36.000000 $900.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 384 557 5566.768252 $139169.2500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 242.857142 $12142.8600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 20 30 133.794946 $6689.7500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10032 13274 102485.423663 $5124276.7800 $50.0000
INTR -T1013 INTERPRETER 182 236 1342.584668 $67129.3000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5964 11485 65159.013900 $651590.6900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1345 1700 12211.654116 $872401.0900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 190 237 1508.053968 $86260.7500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1526 1943 13109.583253 $936549.0300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 131 168 1054.465671 $60273.2800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 15 16 4.133638 $268.6800 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.917199 $227.2900 $118.5500
SENS -V5050 IN EAR MONAURAL HEARING AID 22 24 12.732268 $3019.0400 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
5 6 0.715069 $169.5400 $237.1000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 9 10 4.376179 $2075.3700 $474.2400
SENS -V5264 EARMOLD 66 76 82.854277 $1491.3700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2352 3000 21539.584509 $1538789.1300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 11 57.333332 $3279.4800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 77 82 619.212367 $8594.6800 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 5 7 48.320635 $24.1600 $0.5000
TRAV -TRAVS Travel by mile 2006 3923 391291.282293 $174124.6400 $0.4500
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Subtotal (Total Children Is Unduplicated) 12697 50607 638926.552295 $12300982.2500 $19.2500
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Total 56387 644819.763474 $12597526.7500 $19.5400
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Number of Children (Unduplicated) With at Least One Authorization 13084