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: 01-01-17 and 03-31-17 Date of Report: 05-05-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 57373 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
SCONLY-SCONLY *SERVICE COORDINATION ONLY 333 382 1208.743212 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 23 25 177.864286 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 19 19 18.463493 $683.1500 $37.0000
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Subtotal (Total Children Is Unduplicated) 369 426 1405.070991 $683.1500 $0.4900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 219 307 278.263585 $13495.8200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 32 32 12.561112 $645.0200 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 11 13 11.191270 $200.5500 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 469 487 384.052380 $8199.5200 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 15 13.581223 $171.2600 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 121 131 95.802282 $2064.5400 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 35 39 19.106846 $157.8200 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 8 9 8.791270 $79.6500 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 40 44 38.454464 $973.2900 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 9 10 9.074603 $317.3400 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 43 45 23.791269 $1835.0200 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 5 5 4.246575 $197.1300 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 27 30 9.234624 $171.3100 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 52 55 39.871788 $824.5500 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 22 26 27.567797 $1240.5500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 32 40 37.187966 $4276.6400 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 0.123288 $15.4100 $125.0100
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 3 2.216667 $277.0900 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 22 32 25.458290 $1272.9300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 403 425 567.006652 $28350.3300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 1.050000 $78.7500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 70 86 99.102005 $7432.6500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 72 122 81.030287 $6077.2800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 11 19.950487 $1496.3000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 56 75 66.272060 $4970.3900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 116 178 148.259337 $8228.3800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 518 519 600.009164 $45000.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 256 257 355.859563 $26689.5600 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 130 130 134.827980 $10112.1100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 477 478 539.238338 $29927.7400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 213 219 238.180664 $17863.5700 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 0.286073 $14.3000 $49.9900
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 21 27 90.984917 $4549.2600 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 43 44 16.090760 $821.4400 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 40 41 13.367460 $682.4100 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 314 326 187.185327 $9555.8200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 13 14 5.167277 $263.7900 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 25 26 16.642389 $849.6000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 175 210 132.140613 $6745.7600 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 49 50 18.394488 $939.0300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 31 35 9.780060 $499.2700 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 241 252 319.845387 $16328.1600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 15 15 9.074127 $463.2400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 26 27 14.115677 $720.6000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 162 195 116.599864 $5952.4600 $51.0500
SCREEN-T1023 SCREENING 44 46 32.174657 $1608.7300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 6 3.642010 $54.6300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 13 13 6.860349 $350.2200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 12 12 5.841096 $298.1900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 643 706 509.432562 $26006.5900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 41 41 25.248206 $1288.9300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.211111 $10.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 3612 5915 5424.448246 $300646.2800 $55.4200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 245 308 235.183974 $1175922.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 16 13.477778 $673.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 58 63 256.121789 $12806.1000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 11 14 14.015874 $1003.6800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 53 54 73.684333 $16947.3900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 936 1245 913.244870 $45662.4400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 93 105 66.226846 $1655.6900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3811 5565 8937.555976 $446877.7100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 270 338 796.634122 $19915.8400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1149 1557 2720.642169 $136032.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 84 115 138.238097 $3455.9600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 995 1266 2191.732878 $109586.6400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 46 60 64.216664 $1605.4100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2703 3300 4820.720661 $241036.0300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 213 278 710.893649 $17772.3400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 14 20 68.393652 $5014.6300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 385 513 6585.816665 $164645.3600 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 22.471429 $1123.5700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 19 25 121.573059 $6078.6500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10079 13285 100867.080185 $5043350.6400 $50.0000
INTR -T1013 INTERPRETER 197 249 1491.795180 $74589.7200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6015 11497 64625.306249 $646252.6600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1341 1715 11801.222535 $843078.9200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 196 266 1758.105949 $100563.6400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1463 1914 12446.527270 $889179.5900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 113 140 913.528572 $52217.2500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 12 12 7.798174 $506.8900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 5 1.888585 $215.3100 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 21 24 11.217581 $2557.6600 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
5 7 8.506850 $1939.5500 $228.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 13 14 18.938194 $8635.8200 $456.0000
SENS -V5264 EARMOLD 65 78 82.743857 $1489.3900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2245 2855 20002.661020 $1428989.4900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 33.642857 $1924.3700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 56 59 443.570648 $6156.7600 $13.8800
TRAV -TRAVS Travel by mile 2008 4063 409120.842954 $182058.7700 $0.4500
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Subtotal (Total Children Is Unduplicated) 12635 51032 652386.221145 $11691522.2900 $17.9200
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Total 57373 659215.740382 $11992851.7200 $18.1900
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Number of Children (Unduplicated) With at Least One Authorization 13093