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 49014 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 400 429 1054.527466 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 30 33 128.913850 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 5 5 10.004763 $370.1800 $37.0000
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Subtotal (Total Children Is Unduplicated) 433 469 1194.696079 $416.4300 $0.3500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 260 360 278.226492 $13494.0500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 11 11 5.593987 $263.4200 $47.0900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 1.704055 $25.4400 $14.9300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 144 146 101.907142 $1956.6100 $19.2000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 6 3.154055 $32.8700 $10.4200
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 9 10.744563 $235.8400 $21.9500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 9 5.370721 $46.9900 $8.7500
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 3 1.720493 $13.8700 $8.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 7 3.348499 $73.1300 $21.8400
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.624603 $46.9500 $28.9000
AUDE -92585 AUD EVOKED RESPONSE (COMP) 23 29 14.531146 $946.5500 $65.1400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 2.496119 $57.1600 $22.9000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 54 56 32.998492 $842.4300 $25.5300
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 16 6.548554 $306.4700 $46.8000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 17 7.659361 $916.0600 $119.6000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.066667 $133.3400 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 22 24 13.377089 $668.8600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 502 528 749.820936 $37491.0400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 31 31 26.724294 $2004.3100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 43 44 24.427775 $1832.0600 $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 16 16 16.064056 $1204.8100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 57 59 40.408576 $2242.6600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 84 85 101.145882 $7585.9700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 29 29 34.743832 $2605.8000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 25 25 32.591324 $2444.3500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 131 132 162.772162 $9033.8600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 36 37 40.496954 $3037.2800 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 4.428571 $221.4300 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 38 45 25.051390 $1278.8600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 215 236 150.579476 $7687.0900 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 45 54 34.521535 $1762.3000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 130 143 78.939933 $4029.9000 $51.0500
SCREEN-T1023 SCREENING 21 28 13.135172 $656.7700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 7 13.444444 $209.7300 $15.6000
SPCH -92521 EVAL OF SPEECH FLUENCY 6 6 4.136987 $211.1900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 1.574277 $80.3700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 323 360 237.555868 $12127.2200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 17 18 10.569984 $539.6000 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 4 4 2.222222 $111.1100 $50.0000
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Subtotal (Total Children Is Unduplicated) 1887 2597 2298.644355 $118599.0200 $51.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 133 171 106.768982 $533847.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 8 9 4.450000 $222.5000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 73 78 531.481974 $26574.1000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 13.142857 $941.1600 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 4.216666 $301.9500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 22 23 9.970625 $2385.0200 $239.2000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1164 1556 1178.075220 $58903.8700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 84 104 86.984548 $2174.6300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5042 7562 12634.870200 $631743.7700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 339 466 1271.553971 $31788.8900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1516 2072 3610.500951 $180524.9800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 69 92 155.141270 $3878.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1245 1591 2790.522681 $139526.1200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 36 42 76.503171 $1912.5800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3651 4527 6694.099928 $334704.9500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 250 324 1000.163497 $25004.1400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 4 12.333334 $904.2800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 48 64 453.185714 $11329.6500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 8 375.857142 $18792.8600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 15 20 133.923809 $6696.2000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2860 3736 28984.025537 $1449202.2000 $50.0000
INTR -T1013 INTERPRETER 211 260 1754.445498 $87722.2800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7817 14988 88063.462834 $880635.0400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 535 699 5316.709532 $379825.8300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 59 71 484.688093 $27724.1800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 550 697 4910.760400 $350824.8200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 52 66 394.593654 $22554.9800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 10 5.104718 $331.8100 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 2.000000 $237.1200 $118.5600
SENS -V5050 IN EAR MONAURAL HEARING AID 7 11 11.778387 $2792.8900 $237.1200
SENS -V5060 BEHIND EAR HEARING AID
4 4 3.331507 $789.9900 $237.1300
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 14 17 11.369710 $5391.9700 $474.2400
SENS -V5264 EARMOLD 31 44 37.334547 $672.0100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1226 1536 11412.250145 $815291.6000 $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 33 33 325.980953 $4524.6200 $13.8800
TRAV -TRAVS Travel by mile 2575 5055 554207.146023 $246622.2000 $0.4500
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Subtotal (Total Children Is Unduplicated) 13577 45948 727070.013792 $6287374.7200 $8.6500
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Total 49014 730563.354226 $6406390.1700 $8.7700
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Number of Children (Unduplicated) With at Least One Authorization 14087