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
Eligibility Filter: Program Patients
With the filters selected there were 80812 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 1.700000 $62.9000 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 414 469 1319.513055 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 26 28 195.402382 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 25 25 27.230160 $1007.5200 $37.0000
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Subtotal (Total Children Is Unduplicated) 460 523 1543.845597 $1070.4200 $0.6900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 313 442 422.161910 $20474.9000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 42 42 26.254763 $1348.1800 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 23 25 26.619841 $477.0300 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 685 709 561.699999 $11992.3000 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 33 30.345868 $382.6600 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 166 182 121.578842 $2620.0300 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 64 70 42.574079 $351.6600 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 15 16 19.497619 $176.6500 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 67 73 61.405259 $1554.1700 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 19 20 24.603174 $860.3700 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 82 89 45.593171 $3516.6000 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 9 9 6.509588 $302.1800 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 50 57 22.827927 $423.4600 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 86 91 69.958656 $1446.7500 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 46 54 47.695728 $2146.3100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 69 84 91.302384 $10499.8200 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 0.123288 $15.4100 $125.0100
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 5 6 4.322223 $540.2900 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 28 43 36.307984 $1815.4200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 587 612 818.481916 $40924.0800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 1.384246 $103.8200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 95 113 129.977729 $9748.3400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 90 155 104.124730 $7809.3500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 12 21.950487 $1646.3000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 80 104 98.021602 $7351.6100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 144 213 176.365807 $9788.2900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 705 706 809.922161 $60744.3500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 333 334 464.974622 $34873.2200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 179 180 194.414279 $14581.0900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 634 637 698.656144 $38775.4100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 281 287 311.904633 $23392.8700 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 0.286073 $14.3000 $49.9900
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 2.933333 $146.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 43 54 190.699199 $9534.9800 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 64 65 31.920962 $1629.5800 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 61 65 18.829637 $961.2600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 471 487 301.561285 $15394.7300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 21 23 9.368646 $478.2700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 54 57 33.980538 $1734.7200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 278 330 195.602474 $9985.5100 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 76 79 32.763284 $1672.5600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 45 52 14.768950 $753.9600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 330 350 366.387262 $18704.1200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 23 24 12.950611 $661.1300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 39 41 22.752965 $1161.5400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 256 312 171.835675 $8772.2400 $51.0500
SCREEN-T1023 SCREENING 73 77 54.982265 $2749.1000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 10 11 8.211036 $123.1700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 19 19 12.115905 $618.5200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 22 22 23.650218 $1207.3500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1132 1273 855.188107 $43657.4500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 77 78 54.498294 $2782.1400 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 3 4 1.272222 $63.6100 $50.0000
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Subtotal (Total Children Is Unduplicated) 5399 8831 7908.119600 $433489.8000 $54.8200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 367 476 420.652158 $2103263.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 25 33 24.943152 $1247.1700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 144 161 335.048314 $16752.4400 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 9.571429 $685.4100 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 16 20 17.056970 $1221.4500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 94 98 100.159901 $23036.7500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1314 1751 1271.102936 $63555.4000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 131 143 88.535497 $2213.4000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5074 7452 12600.077044 $630003.7300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 332 422 953.766663 $23844.1400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1720 2325 4130.685817 $206534.1700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 103 144 164.382542 $4109.5700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1373 1768 3108.016171 $155400.7700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 53 68 70.761108 $1769.0200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3856 4757 7240.022057 $362001.1100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 269 349 868.635712 $21715.8800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 16 22 72.049208 $5282.6600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 503 678 8443.059519 $211076.4300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 8 275.185714 $13759.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 23 29 142.850837 $7142.5400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 13345 17627 133063.551306 $6653173.2100 $50.0000
INTR -T1013 INTERPRETER 217 273 1628.068044 $81403.3600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7929 15467 87056.564922 $870565.1300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2137 2769 18913.326035 $1351167.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 272 362 2349.208335 $134374.6700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2259 2996 19504.277341 $1393385.0300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 150 182 1157.946429 $66188.1800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 22 22 12.044139 $782.8900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 6 2.118722 $241.5400 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 38 42 22.099240 $5038.6600 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
13 15 14.682574 $3347.6300 $228.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 34 36 46.822679 $21351.2000 $456.0000
SENS -V5264 EARMOLD 134 165 180.997424 $3257.9600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4071 5301 37135.046227 $2652926.4400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 11 11 82.928571 $4743.5200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 92 95 721.380169 $10012.7600 $13.8800
TRAV -TRAVS Travel by mile 2583 5384 522516.358544 $232519.7800 $0.4500
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Subtotal (Total Children Is Unduplicated) 17672 71458 864743.983450 $17339094.1500 $20.0500
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Total 80812 874195.948647 $17773654.3700 $20.3300
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Number of Children (Unduplicated) With at Least One Authorization 18298