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
Eligibility Filter: Program Patients
With the filters selected there were 80605 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 2 2 1.250000 $46.2500 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 409 438 1080.205244 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 30 33 128.913850 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 30 31 36.917463 $1365.9500 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 465 504 1247.286557 $1412.2000 $1.1300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 298 409 296.589356 $14384.6800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 53 55 40.378110 $1901.3900 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 27 30 25.083323 $374.5000 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 878 929 595.095240 $11425.8300 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 33 37 30.554479 $318.3800 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 160 167 110.087683 $2416.4300 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 64 67 52.350989 $458.0800 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 18 20 16.647479 $134.1800 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 65 68 68.082736 $1486.9500 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 16 18 16.551589 $478.3400 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 82 93 42.797357 $2787.8200 $65.1400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 7 7 4.518037 $173.3600 $38.3700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 40 41 17.905632 $410.0600 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 73 77 55.092145 $1406.4900 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 51 59 48.988060 $2292.6300 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 65 75 67.598236 $8084.7100 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 4 4 5.066667 $633.3400 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 4 4 4.533333 $566.6600 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 29 34 18.748701 $937.4400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 505 531 754.678079 $37733.9000 $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 85 105 100.491109 $7536.8200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 71 112 79.812172 $5985.8900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 20 20 20.065525 $1504.9200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 52 60 62.044191 $4653.3000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 112 165 147.456880 $8183.8500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 667 675 829.881076 $62241.4700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 244 244 247.611486 $18571.0400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 189 189 203.188559 $15239.2200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 625 628 949.943693 $52721.9700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 202 225 267.690855 $20076.8200 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 4.428571 $221.4300 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.444444 $22.2200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 41 62 227.148420 $11357.4200 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 98 118 69.913469 $3569.0700 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 797 879 555.839467 $28375.6200 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 124 148 87.110707 $4446.9800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 614 691 562.489490 $28715.1300 $51.0500
SCREEN-T1023 SCREENING 85 92 59.080923 $2954.0600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 9 11 15.763165 $245.9000 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 17 17 12.506850 $638.4800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 11 11 5.563699 $284.0300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1073 1207 876.143933 $44727.1600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 62 63 60.308123 $3078.7300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 6 6 3.733333 $186.6700 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 5278 8460 7721.725104 $414072.1400 $53.6200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 357 456 346.854793 $1734283.5000 $5000.0300
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 22 31 18.754109 $937.7000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 152 162 626.231843 $31311.5800 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 13.142857 $941.1600 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 18 18 15.031745 $1076.4200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 85 88 100.745469 $24098.3900 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1386 1821 1507.167232 $75358.4600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 152 173 120.437341 $3010.9500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5213 7807 13258.233702 $662911.9100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 340 469 1278.636511 $31965.9500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1621 2204 3966.742141 $198337.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 72 95 157.146826 $3928.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1368 1742 3167.453500 $158372.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 37 43 76.636504 $1915.9100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3824 4739 7257.434854 $362871.6600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 259 334 1030.388896 $25759.7700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 20 27 77.338890 $5670.5000 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 25.142857 $628.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 553 715 10566.409520 $264160.3100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 9 402.142856 $20107.1400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 21 27 162.462491 $8123.1400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13410 17748 137730.547471 $6886531.6400 $50.0000
INTR -T1013 INTERPRETER 215 267 1793.193116 $89659.6600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7833 15040 88417.327177 $884173.6900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2200 2911 20612.950839 $1472589.7100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 265 333 2197.376193 $125689.9900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2384 3086 21061.210346 $1504613.2300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 177 224 1382.608367 $79029.8800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 23 24 8.753577 $569.0000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 6 3.915068 $464.1700 $118.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 31 36 30.092241 $7135.4900 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
9 9 4.580823 $1086.2200 $237.1200
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 34 39 47.196139 $22382.3700 $474.2400
SENS -V5264 EARMOLD 128 161 195.480266 $3518.6200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4301 5575 40387.112123 $2885256.7100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 9 9 58.000001 $3317.6000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 103 106 817.650208 $11348.9900 $13.8800
TRAV -A0160 *PROV TRAVEL TO NATURAL ENV-BY MIN 2 3 5.285714 $2.6400 $0.5000
TRAV -TRAVS Travel by mile 2585 5102 557888.488621 $248260.4000 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 17940 71641 916816.303227 $17841401.3600 $19.4600
-------------------------------------------------------------------------------------------------------------------------------------
Total 80605 925785.314888 $18256885.7000 $19.7200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 18559