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 32600 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 328 376 1196.397180 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 23 25 177.864286 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 345 401 1374.261466 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 205 286 269.427664 $13067.2700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 0.161111 $8.2700 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 3.785714 $67.8400 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 63 65 59.857936 $1277.9700 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 3.785714 $47.7400 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 4.224070 $91.0300 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 3.830158 $31.6400 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 3.785714 $34.3000 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 3.830158 $96.9400 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 3.785714 $132.3900 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 6 6 6.396825 $493.3900 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 0.044444 $0.8200 $18.5300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 30 32 25.721787 $531.9200 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.205555 $54.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.676484 $192.8000 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 0.123288 $15.4100 $125.0100
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 16 22 20.277471 $1013.8800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 401 423 565.803912 $28290.1900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 18 18 7.755480 $581.6700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 47 49 20.411111 $1530.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.500000 $37.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 23 23 21.079365 $1580.9500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 64 65 38.806989 $2153.7800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 18 18 15.842010 $1188.1500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 6.005479 $450.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 12.009589 $900.7200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 17 17 24.015070 $1332.8300 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 7 7.750685 $581.3000 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 0.286073 $14.3000 $49.9900
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 11 11 3.873896 $197.7600 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 11 11 3.594445 $183.5000 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 41 41 24.501717 $1250.8000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 2 3 0.602132 $30.7400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 27 31 36.799164 $1878.6100 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 9 9 6.018005 $307.2100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 10 3.472222 $177.2600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 30 32 12.941476 $660.6700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 3 1.089422 $55.6100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.353425 $18.0400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 14 14 25.057232 $1279.1800 $51.0500
SCREEN-T1023 SCREENING 4 4 1.116666 $55.8300 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.0500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 109 113 96.064842 $4904.1200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 8 8 11.002381 $561.6700 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.211111 $10.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 1026 1361 1360.883706 $67548.1000 $49.6400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 60 72 33.148321 $165741.0000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 1.600000 $80.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 37 37 227.564221 $11378.2100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 3.005556 $215.2300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 4.363014 $1003.4900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 836 1126 809.123706 $40456.3600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 47 55 39.806585 $995.1800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3734 5475 8751.348837 $437567.3300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 268 336 795.134122 $19878.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1114 1520 2608.468361 $130423.3700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 84 115 138.238097 $3455.9600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 940 1207 2045.928258 $102296.4000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 46 60 64.216664 $1605.4100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2629 3221 4646.347649 $232317.3600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 212 277 708.893649 $17722.3400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.100000 $7.3300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 8 40.590478 $1014.7600 $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 13 18 101.290476 $5064.5200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 453 560 4043.023817 $202151.0400 $50.0000
INTR -T1013 INTERPRETER 195 247 1480.366609 $74018.2900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6012 11480 64545.293550 $645452.5300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 169 212 1592.181938 $113745.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 29 36 262.750000 $15029.2900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 218 248 1750.840471 $125080.0100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 17 21 155.461907 $8886.1700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 6 6.973516 $453.2800 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.246575 $28.1100 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 5 5 4.125799 $940.6800 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
1 2 1.098630 $250.4800 $227.9900
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 5 5 2.563242 $1168.8600 $456.0100
SENS -V5264 EARMOLD 9 9 9.021537 $162.3900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 340 409 2998.405360 $214206.0000 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 9 9 91.571428 $1271.0100 $13.8800
TRAV -TRAVS Travel by mile 2005 4045 408561.700097 $181809.9500 $0.4500
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Subtotal (Total Children Is Unduplicated) 9463 30838 506547.263899 $2756999.6200 $5.4400
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Total 32600 509282.409071 $2824547.7200 $5.5500
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Number of Children (Unduplicated) With at Least One Authorization 9841