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 48381 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 347 383 662.302323 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 23 25 119.259525 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 11 11 10.492856 $388.2300 $37.0000
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Subtotal (Total Children Is Unduplicated) 380 420 792.632482 $409.6100 $0.5200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 244 331 188.813828 $9157.5600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 10 11 4.929831 $232.1400 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 0.504110 $7.5300 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 158 162 76.679363 $1472.2400 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 5 2.270776 $23.6600 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 1.046576 $22.9800 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 7 3.715221 $32.5100 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.252055 $2.0300 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 5 5 2.037443 $44.5000 $21.8400
AUDE -92585 AUD EVOKED RESPONSE (COMP) 19 21 11.557611 $752.8700 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 4.071429 $156.2200 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 1.015221 $23.2500 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 41 43 17.290563 $441.4300 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 14 7.802892 $365.1800 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 15 8.461340 $1011.9800 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 3.088889 $386.1100 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 43 51 62.808909 $3140.4700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 564 614 697.567806 $34878.3700 $50.0000
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 20 20 37.363338 $2802.2500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 29 29 15.672222 $1175.4200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.405556 $180.4200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 16 17 9.466513 $709.9900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 40 40 21.994366 $1220.6800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 82 82 87.876960 $6590.8400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 30 30 23.385057 $1753.9100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 4.599541 $344.9800 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 87 87 89.063744 $4943.0500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 49 51 46.330743 $3474.8200 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 14.142857 $707.1500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 31 35 40.522690 $2068.6900 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 220 240 182.922933 $9338.2500 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 41 44 39.721506 $2027.7800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 145 163 102.674656 $5241.5400 $51.0500
SCREEN-T1023 SCREENING 19 23 20.470711 $1023.5400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 4 4.184779 $65.2800 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.050000 $2.5500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 0.804261 $41.0600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 345 385 296.926409 $15158.1200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 18 18 12.480104 $637.1100 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 5 5 1.898555 $94.9300 $50.0000
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Subtotal (Total Children Is Unduplicated) 1915 2583 2149.226920 $111773.1100 $52.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 115 159 91.240664 $456207.0000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 9 7.994443 $399.7200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 134 142 631.779633 $31588.9600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 7.243651 $518.7100 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 25 26 9.862176 $2359.0400 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1293 1645 1614.752275 $80737.7200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 69 84 124.345271 $3108.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5007 7999 13855.749520 $692787.9700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 302 419 1665.640466 $41641.0700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1307 1652 2832.716767 $141635.9200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 56 64 135.543652 $3388.5900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1091 1326 2186.004209 $109300.3200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 29 32 57.163492 $1429.0900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3236 3877 5657.658860 $282882.7900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 173 197 765.539705 $19138.5300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 15.127778 $1109.1700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 87 105 741.923809 $18548.1100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 11 530.000000 $26500.0000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 21 32 147.923016 $7396.1600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2842 3686 28568.262694 $1428414.4900 $50.0000
INTR -T1013 INTERPRETER 201 256 1509.817284 $75490.9400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7869 15337 87443.269027 $874433.4200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 562 684 5408.745223 $386401.0000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 57 63 358.493650 $20505.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 553 680 4755.571895 $339738.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 58 73 567.135715 $32417.5100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 12 12 4.003501 $260.2300 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 7 7 7.026180 $1666.0500 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
5 6 1.671233 $396.2700 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 8 9 6.013166 $2851.7000 $474.2400
SENS -V5264 EARMOLD 29 33 32.314000 $581.6500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1250 1524 11281.012261 $805916.1100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 3 13.476190 $770.8400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 44 47 459.428569 $6376.8800 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 3 4 8.892064 $4.4500 $0.5000
TRAV -TRAVS Travel by mile 2605 5167 524557.048355 $233427.9100 $0.4500
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Subtotal (Total Children Is Unduplicated) 13479 45378 696060.390394 $6130330.9900 $8.8100
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Total 48381 699002.249796 $6242513.7100 $8.9300
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Number of Children (Unduplicated) With at Least One Authorization 13886