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 32260 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 324 348 932.087674 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 26 29 116.701586 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 348 378 1049.039260 $9.2500 $0.0100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 196 279 209.679687 $10169.5100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 1.055099 $49.6800 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.285714 $19.2000 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 88 89 62.235713 $1194.9200 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.285714 $13.4000 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 4 4 10.054761 $220.7000 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 1.285714 $11.2500 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.285714 $10.3600 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.285714 $28.0800 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.285714 $37.1600 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 7 2.385714 $155.4000 $65.1400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 35 36 22.665161 $578.6300 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 6 3.494445 $163.5400 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 3.526332 $421.7600 $119.6000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 20 22 10.955171 $547.7600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 354 375 556.107128 $27805.3700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 18 18 8.138887 $610.4000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 28 28 11.472219 $860.3900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.216667 $16.2500 $75.0100
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 9 9 14.519841 $1088.9900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 43 45 28.700356 $1592.8500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 17.782190 $1333.6700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 7.510958 $563.3300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 5.505479 $412.9100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 18 18 24.030136 $1333.6800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 8 9.410197 $705.7700 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 4.428571 $221.4300 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 14 16 6.127778 $312.8200 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 78 83 46.630344 $2380.4800 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 14 19 13.665189 $697.6000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 45 49 20.838280 $1063.8000 $51.0500
SCREEN-T1023 SCREENING 10 12 5.423973 $271.2000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 3 1.977778 $30.8500 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.084932 $4.3300 $51.0300
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 96 106 72.950014 $3724.1200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 5 5 3.143652 $160.4900 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 3 3 1.711111 $85.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 976 1283 1195.142047 $59022.6400 $49.3900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 56 76 34.908370 $174542.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 5 2.466666 $123.3300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 57 60 507.648555 $25382.4300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.511111 $36.6000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 2.481506 $593.5700 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 856 1161 885.996123 $44299.8600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 64 80 65.342924 $1633.5800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3833 5732 9155.308608 $457765.4500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 264 356 942.477778 $23561.9700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1050 1432 2371.678326 $118583.8000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 56 77 134.663491 $3366.5800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 934 1194 2032.796880 $101639.7900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 33 39 74.130949 $1853.2700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2607 3215 4582.832635 $229141.6200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 196 263 798.742068 $19968.6000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 2 0.533334 $39.1100 $73.3300
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 9 98.771427 $2469.2900 $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 13 17 117.057142 $5852.8600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 442 563 4018.116658 $200905.9500 $50.0000
INTR -T1013 INTERPRETER 182 227 1614.068589 $80703.4300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5912 11249 65519.161923 $655191.9000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 177 217 1556.426988 $111191.1500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 31 39 247.999998 $14185.6100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 219 270 1807.596832 $129134.7300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 22 27 169.664287 $9698.0200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 1.964688 $127.7100 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 5 7 7.526332 $1784.6600 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
2 2 0.331507 $78.6300 $237.1900
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 7 9 4.106544 $1947.4700 $474.2300
SENS -V5264 EARMOLD 9 16 11.600607 $208.8100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 359 444 3112.067924 $222326.2700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.285714 $73.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 13 13 110.785714 $1537.7100 $13.8800
TRAV -TRAVS Travel by mile 1961 3780 420664.479278 $187195.7100 $0.4500
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Subtotal (Total Children Is Unduplicated) 9490 30599 520788.531476 $2833795.4600 $5.4400
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Total 32260 523032.712783 $2892827.3500 $5.5300
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Number of Children (Unduplicated) With at Least One Authorization 9854