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: 04-01-17 and 06-30-17 Date of Report: 08-05-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 60655 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 339 373 1176.827404 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 21 23 126.569046 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 14 16 16.099999 $595.7000 $37.0000
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Subtotal (Total Children Is Unduplicated) 370 412 1319.496449 $595.7000 $0.4500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 219 297 236.744485 $11482.1200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 31 36 14.803971 $760.2000 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 12 14 8.300230 $148.7400 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 542 576 510.388897 $10896.8200 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 15 9.003959 $113.5400 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 117 120 91.852893 $1979.4500 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 34 35 17.456165 $144.1900 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 6 6 3.244445 $29.4000 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 37 38 32.195108 $814.8600 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 13 13 9.750001 $340.9600 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 32 35 15.350006 $1183.9900 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 3.000000 $139.2600 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 22 23 9.374201 $173.8900 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 49 54 39.603500 $819.0000 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 18 20 22.565297 $1015.4400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 25 27 32.794519 $3771.3600 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 3 1.211111 $151.3900 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 24 33 28.155083 $1407.7600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 466 496 606.759302 $30337.9500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 7 5.082540 $381.2000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 70 94 159.020171 $11926.5400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 67 121 89.226189 $6692.0400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 11 14 11.016590 $826.2500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 64 91 96.369813 $7227.7500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 104 170 118.466537 $6574.9500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 500 501 662.520430 $49689.1100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 220 220 368.083271 $27606.2800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 139 139 180.697331 $13552.3300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 478 484 749.004352 $41569.7600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 254 258 378.709709 $28403.2700 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.505556 $25.2800 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.566667 $28.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 19 27 81.676985 $4083.8500 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 19 19 8.023749 $409.6400 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 92 100 47.179008 $2408.5600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 113 113 58.492420 $2986.0600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 28 28 15.187825 $775.3500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 68 71 52.672525 $2688.9300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 412 458 288.685901 $14737.6400 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 18 18 3.978769 $203.1200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 78 90 33.896101 $1730.4800 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 91 92 119.562367 $6103.6900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 18 19 102.050457 $5209.6700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 52 52 38.049710 $1942.4500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 342 397 232.839622 $11886.6700 $51.0500
SCREEN-T1023 SCREENING 54 56 46.038770 $2301.9400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 5 6.044444 $90.6700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 9 9 5.029224 $256.7400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 17 18 8.811090 $449.8100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 722 801 513.326275 $26205.4100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 64 66 50.245468 $2565.0400 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.213699 $10.6900 $50.0000
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Subtotal (Total Children Is Unduplicated) 3907 6385 6223.826738 $347259.7700 $55.8000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 242 289 188.526807 $942636.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 11 12 12.744443 $637.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 43 54 60.396869 $3019.8400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 10 10 18.783334 $1345.0800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 59 62 31.464771 $7237.0700 $230.0100
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 994 1267 967.329581 $48366.7000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 106 122 73.229595 $1830.7400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3991 5932 9513.256494 $475662.4100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 288 358 621.186859 $15529.6700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1230 1677 2812.702352 $140634.9700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 88 139 144.593255 $3614.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1049 1372 2263.529956 $113176.3100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 56 91 87.722226 $2193.0700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2862 3575 5260.238609 $263011.1600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 217 271 538.765078 $13469.1200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 19 21 55.963491 $4103.2400 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 373 610 5840.626166 $146015.7300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 62.571428 $3128.5800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 18 31 131.286402 $6564.3300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10587 14059 109048.551832 $5452427.6100 $50.0000
INTR -T1013 INTERPRETER 186 246 1496.935505 $74846.7500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6329 11979 70591.606723 $705915.9800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1463 1880 12319.978736 $880139.3100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 213 259 1837.750788 $105119.4000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1543 2041 13036.719429 $931343.2200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 122 153 913.965473 $52242.2500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 12 12 8.731812 $567.5700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 3.148249 $358.8900 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 15 16 8.392922 $1913.5600 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
5 5 7.315982 $1668.0500 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
9 12 18.610884 $8486.5700 $456.0000
SENS -V5264 EARMOLD 53 66 72.430762 $1303.7400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2293 2995 20696.667765 $1478570.0000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 44.571429 $2549.4800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 63 66 496.677883 $6893.8900 $13.8800
TRAV -TRAVS Travel by mile 2061 4166 449398.358569 $199982.2700 $0.4500
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Subtotal (Total Children Is Unduplicated) 13199 53858 708685.332459 $12096504.5800 $17.0700
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Total 60655 716228.655646 $12444360.0500 $17.3700
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Number of Children (Unduplicated) With at Least One Authorization 13707