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: 10-01-16 and 12-31-16 Date of Report: 02-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 57469 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 0.250000 $9.2500 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 330 354 953.036881 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 26 29 116.701586 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 24 25 24.212700 $895.8700 $37.0000
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Subtotal (Total Children Is Unduplicated) 376 409 1094.201167 $905.1200 $0.8300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 210 299 218.472991 $10596.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 39 41 30.378111 $1430.4900 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 13 13 8.560219 $127.8000 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 607 644 404.435711 $7765.1600 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 13 13 11.315774 $117.9100 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 114 120 87.489736 $1920.4000 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 31 31 26.712665 $233.7400 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 7 7 4.013492 $32.3500 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 35 35 44.866634 $979.9000 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 7 7 4.013492 $115.9900 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 47 53 21.557481 $1404.2600 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 5 5 3.463242 $132.8900 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 21 21 6.345206 $145.3200 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 42 43 27.515161 $702.4500 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 23 28 30.206022 $1413.6400 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 31 35 40.822536 $4882.3700 $119.6000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 3 3.533333 $441.6600 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 22 24 14.455171 $722.7600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 354 375 556.107128 $27805.3700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 4 1.717733 $128.8300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 59 76 63.507530 $4763.0600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 50 80 53.828839 $4037.1400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 18 18 18.060046 $1354.5100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 34 39 42.807207 $3210.5300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 94 142 127.304216 $7065.3700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 478 483 618.456348 $46384.5300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 188 188 193.494276 $14512.2100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 120 120 125.431488 $9407.4200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 443 444 713.208291 $39583.1500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 149 169 195.006837 $14625.5200 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 4.428571 $221.4300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 18 29 105.942859 $5297.1500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 61 70 30.913059 $1578.1200 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 525 574 362.400424 $18500.5400 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 72 87 57.144544 $2917.2200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 433 481 443.305632 $22630.7700 $51.0500
SCREEN-T1023 SCREENING 58 60 41.724823 $2086.2400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 5 3.252055 $50.7300 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 12 12 8.454795 $431.6200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 3.661644 $186.9300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 610 682 526.499706 $26877.8500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 31 31 27.654404 $1411.7500 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 4 4 2.711111 $135.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 3543 5604 5315.180543 $288368.6300 $54.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 231 306 229.805519 $1149033.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 8 11 7.022221 $351.1100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 79 83 539.035856 $26951.7900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 13 13 10.815079 $774.4700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 51 52 80.530016 $19262.7500 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1006 1342 1011.266939 $50563.4000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 116 133 93.423495 $2335.5900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3917 5851 9409.925276 $470496.2800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 265 358 942.988889 $23574.7500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1097 1496 2514.154104 $125707.5900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 56 77 134.663491 $3366.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1000 1274 2196.922928 $109846.1000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 34 40 74.264282 $1856.6000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2682 3306 4793.324695 $239666.2100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 199 266 801.753179 $20043.8700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 17 23 62.438890 $4578.0300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 418 530 8170.780949 $204269.5800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 3 133.000000 $6650.0000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 18 23 145.576646 $7278.8400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10154 13483 104513.618343 $5225684.0200 $50.0000
INTR -T1013 INTERPRETER 186 234 1652.816207 $82640.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5917 11270 65655.851607 $656558.7900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1386 1808 12653.440908 $903962.1100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 200 250 1637.119051 $93643.2700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1562 2004 13546.211653 $967741.5100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 129 163 1003.693280 $57371.1100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 11 11 3.047337 $198.0900 $65.0100
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 1.652055 $195.8700 $118.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 20 22 18.886152 $4478.3200 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
3 3 0.583562 $138.4100 $237.1800
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 14 17 19.137073 $9075.6300 $474.2400
SENS -V5264 EARMOLD 63 77 100.162027 $1802.9100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2377 3050 21677.209452 $1548620.4300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 43.857143 $2508.6300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 61 63 465.054173 $6454.9600 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 2 3 5.285714 $2.6400 $0.5000
TRAV -TRAVS Travel by mile 1965 3802 421290.560231 $187474.3100 $0.4500
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Subtotal (Total Children Is Unduplicated) 12840 51456 675639.878422 $12215158.3400 $18.0800
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Total 57469 682049.260132 $12504432.0900 $18.3300
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Number of Children (Unduplicated) With at Least One Authorization 13289