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
Eligibility Filter: Program Patients
With the filters selected there were 79411 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 359 397 676.498355 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 23 25 119.259525 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 53 58 62.781745 $2322.9200 $37.0000
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Subtotal (Total Children Is Unduplicated) 432 481 859.117403 $2344.3000 $2.7300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 283 385 205.766720 $9979.7700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 44 45 44.337600 $2087.8300 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 17 19 17.483150 $261.0300 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 749 788 388.100772 $7451.4900 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 27 30 30.281703 $315.5400 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 124 126 70.863447 $1555.4500 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 51 56 44.534182 $389.6800 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 8 9 13.306817 $107.2500 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 53 58 43.080647 $940.8900 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 7 12.054762 $348.3900 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 64 68 34.187443 $2226.9700 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 7.071429 $271.3300 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 32 35 7.937140 $181.7700 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 49 53 32.856435 $838.8300 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 55 61 50.899608 $2382.1100 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 72 84 66.506185 $7954.1300 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 3.088889 $386.1100 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 50 59 71.917248 $3595.8900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 564 614 697.567806 $34878.3700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 8 2.866209 $214.9600 $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 78 89 116.264147 $8719.7900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 70 95 80.525866 $6039.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 16 16 12.848934 $963.6800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 72 84 76.363619 $5727.2600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 115 155 127.043305 $7050.8400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 688 691 904.107531 $67808.5400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 264 264 274.024293 $20552.0900 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 162 162 141.048976 $10578.7900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 605 608 1020.111301 $56616.2700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 269 286 401.171200 $30087.8600 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 14.142857 $707.1500 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 41 50 208.352383 $10417.6100 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 98 112 86.714262 $4426.7700 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 748 808 578.146344 $29514.4400 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 120 135 117.380760 $5992.3100 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 600 676 526.644006 $26885.2300 $51.0500
SCREEN-T1023 SCREENING 90 95 65.396545 $3269.8500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 7 8 6.374200 $99.4400 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 5.195205 $265.2200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 8 8 3.997261 $204.0700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1029 1144 760.048263 $38800.5500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 83 84 64.601272 $3297.9100 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 8 8 3.227626 $161.3800 $50.0000
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Subtotal (Total Children Is Unduplicated) 5173 8099 7438.793904 $414573.9200 $55.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 339 437 384.974409 $1924884.0000 $5000.0300
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 23 27 17.849084 $892.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 213 233 726.598758 $36329.9300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 17 17 26.541607 $1900.6400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 67 69 37.488648 $8967.2200 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1503 1902 1792.312914 $89615.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 133 151 155.024435 $3875.6200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5202 8290 14514.132399 $725707.0800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 305 423 1666.956340 $41673.9700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1420 1797 3198.760885 $159938.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 57 65 136.543652 $3413.5900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1202 1463 2583.728023 $129186.4900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 29 32 57.163492 $1429.0900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3408 4087 6225.561587 $311277.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 179 205 788.996055 $19724.9400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 23 28 104.369047 $7652.3400 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 4 78.571429 $1964.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 516 761 7237.911110 $180947.8500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 13 556.285714 $27814.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 25 36 155.738476 $7786.9300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13244 17555 135059.937780 $6753004.0600 $50.0000
INTR -T1013 INTERPRETER 205 260 1552.990147 $77649.5800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7885 15399 87781.339328 $877814.1200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2203 2838 20419.311549 $1458756.4900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 247 306 1890.947621 $108162.2800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2363 3056 20729.771889 $1480935.5600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 187 240 1567.215672 $89582.0800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 24 26 7.735617 $502.8100 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 5 2.925419 $346.8200 $118.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 38 43 25.472048 $6039.9200 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
10 11 2.706850 $641.8600 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 21 23 23.933572 $11350.2700 $474.2400
SENS -V5264 EARMOLD 129 154 184.254609 $3316.5700 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4286 5506 39687.117339 $2835249.8600 $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 129 138 1070.266730 $14855.3200 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 5 7 48.320635 $24.1600 $0.5000
TRAV -TRAVS Travel by mile 2615 5213 527467.609603 $234723.1100 $0.4500
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Subtotal (Total Children Is Unduplicated) 17741 70831 878024.697804 $17641216.8100 $20.0900
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Total 79411 886322.609111 $18058135.0300 $20.3700
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Number of Children (Unduplicated) With at Least One Authorization 18269