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 49627 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 406 460 1293.870198 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 26 28 195.402382 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 5.500000 $203.5000 $37.0000
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Subtotal (Total Children Is Unduplicated) 431 493 1496.472580 $266.4000 $0.1800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 281 388 404.910997 $19638.2400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 8 5.532540 $284.0900 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 4.285714 $76.8000 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 103 106 91.421429 $1951.8500 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 4 4.388454 $55.3400 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 6 6 5.835181 $125.7500 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 7 7 5.810676 $48.0000 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 4.285714 $38.8300 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 6 6 5.432898 $137.5000 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 4.285714 $149.8700 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 22 25 15.769047 $1216.2600 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 4 4 2.047184 $37.9700 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 52 55 39.035868 $807.2600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 10 4.226484 $190.1900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 16 17 35.155818 $4042.9400 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 0.123288 $15.4100 $125.0100
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 2 3 3.000000 $375.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 19 27 26.288429 $1314.4300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 584 609 817.112509 $40855.6100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.328767 $24.6600 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 30 30 19.155025 $1436.6500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 62 65 30.022222 $2251.6700 $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 38 38 34.445651 $2583.4200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 84 85 53.857980 $2989.1100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 85 85 74.067345 $5555.0800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 22 22 30.032874 $2252.4800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 30 30 34.057535 $2554.3100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 116 116 102.369865 $5681.5100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 31 31 15.447256 $1158.5600 $75.0000
NURS -T1001 NURSING ASSESSMENT 2 2 0.286073 $14.3000 $49.9900
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 21 21 7.920470 $404.3300 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 22 25 7.227170 $368.9500 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 105 106 66.112338 $3375.0300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 7 8 1.405175 $71.7300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 12 6.600630 $336.9700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 69 80 62.199208 $3175.2900 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 24 25 15.284670 $780.2700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 19 23 7.622223 $389.1200 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 65 68 28.045966 $1431.7500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 7 2.633258 $134.4200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 9 9 4.959360 $253.1800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 53 68 44.907470 $2292.5300 $51.0500
SCREEN-T1023 SCREENING 12 13 5.823667 $291.1900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 3.911111 $58.6700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 4.000000 $204.2000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 16.051588 $819.4300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 323 355 265.797748 $13569.0200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 23 23 17.695152 $903.3300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.566667 $28.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 1947 2646 2442.282408 $126788.3300 $51.9100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 134 172 100.385684 $501928.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 4.600000 $230.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 54 56 251.474691 $12573.7300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 9.571429 $685.4100 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 5.546652 $397.2000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 24 25 13.026255 $2996.0300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1151 1552 1090.408671 $54520.6600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 67 75 52.094675 $1302.3800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4933 7281 12229.514353 $611475.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 330 419 950.909520 $23772.7100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1643 2244 3908.931841 $195446.4900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 101 142 162.382542 $4059.5700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1282 1667 2891.416748 $144570.8000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 52 67 69.761108 $1744.0200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3710 4598 6871.010157 $343550.4900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 263 341 849.497617 $21237.4300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 3.700000 $271.2800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 51 74 343.566668 $8589.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 7 251.471428 $12573.5800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 16 21 121.601587 $6080.0800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2850 3698 28302.824401 $1415140.2800 $50.0000
INTR -T1013 INTERPRETER 215 271 1616.639473 $80831.9300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 7923 15432 86898.095079 $868980.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 518 643 4964.739086 $354680.7200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 57 71 513.980957 $29399.6900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 541 661 4675.271100 $334001.1900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 38 45 305.728575 $17475.4200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 9 9.466666 $615.3400 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.246575 $28.1100 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 10 10 8.761112 $1997.5500 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
3 4 4.098630 $934.4800 $228.0000
SENS -V5140 BEHIND THE EAR BINAURAL HEARING AI 13 13 10.287595 $4691.1900 $456.0000
SENS -V5264 EARMOLD 32 36 33.203424 $597.6600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1167 1464 10836.774693 $774178.7700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 23 23 229.171426 $3180.9000 $13.8800
TRAV -TRAVS Travel by mile 2576 5353 520559.220449 $231648.8500 $0.4500
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Subtotal (Total Children Is Unduplicated) 13468 46488 689149.380867 $6066387.0800 $8.8000
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Total 49627 693088.135855 $6193441.8100 $8.9400
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Number of Children (Unduplicated) With at Least One Authorization 13994