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 34286 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 335 369 1170.560738 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 21 23 126.569046 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 352 392 1297.129784 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 202 268 222.087862 $10771.2800 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 0.183562 $3.2900 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 82 85 79.416671 $1695.5600 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.183562 $2.3200 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.011112 $21.7900 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.194673 $9.8700 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.219330 $30.8600 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 1.461112 $112.7000 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 1 1 1.011111 $18.7600 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 17 18 10.953500 $226.5200 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.427778 $64.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.190715 $136.9300 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 20 26 24.116729 $1205.8400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 462 492 603.024751 $30151.2300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.127778 $9.5900 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 25 25 18.672227 $1400.4500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 52 54 24.494456 $1837.1700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 3.477777 $260.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 32 32 21.643656 $1623.3100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 64 65 30.215809 $1677.0400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 20 20 20.124655 $1509.3600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 26.000000 $1950.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 18.521916 $1027.9700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 11.093150 $831.9900 $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 1 1 2.833333 $141.6700 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 4 4 2.044445 $104.3700 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 20 23 7.982651 $407.5300 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 15 15 5.154872 $263.1600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 0.752131 $38.4000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 9 7.277777 $371.5300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 52 56 34.827391 $1777.9700 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 0.415982 $21.2400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 15 17 6.149320 $313.9500 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 12 13 6.954110 $355.0100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 3 0.710426 $36.2700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 7 4.644977 $237.1200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 32 33 31.599328 $1613.1500 $51.0500
SCREEN-T1023 SCREENING 1 1 0.900000 $45.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.438889 $73.4600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.344444 $17.5800 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 110 126 76.853168 $3923.3800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 14 14 12.873070 $657.1700 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.213699 $10.6900 $50.0000
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Subtotal (Total Children Is Unduplicated) 1120 1481 1332.896128 $67356.1400 $50.5300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 53 59 30.450911 $152253.5000 $4999.9700
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 2.544444 $127.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 26 29 33.527822 $1676.3900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.033333 $73.9900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 11 12 6.148098 $1414.0900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 861 1104 829.831822 $41491.8300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 43 55 32.747580 $818.7000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3931 5864 9432.827127 $471640.9400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 284 352 617.297178 $15432.4300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1208 1653 2790.946794 $139547.1900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 88 139 144.593255 $3614.8300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1010 1324 2210.724496 $110536.0300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 55 90 87.711115 $2192.7900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2808 3515 5202.732260 $260135.8500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 216 270 538.498411 $13462.4500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 4 4 9.565080 $701.3200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 25 28 118.340475 $2958.5300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 51.428571 $2571.4300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 10 19 103.630954 $5181.5600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 452 544 4322.103973 $216105.2100 $50.0000
INTR -T1013 INTERPRETER 184 242 1483.067251 $74153.3400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6328 11972 70540.821010 $705408.1200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 187 213 1609.753939 $115000.8000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 22 26 227.821429 $13031.3800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 214 256 1726.275393 $123325.0900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 16 22 186.276190 $10647.5500 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 7 7.783866 $505.9500 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.126027 $14.3600 $113.9800
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 3.239345 $738.5600 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
4 4 1.350457 $615.7800 $455.9800
SENS -V5264 EARMOLD 9 9 6.053577 $108.9600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 346 419 3206.065867 $229041.3800 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 13 13 134.214284 $1862.9000 $13.8800
TRAV -TRAVS Travel by mile 2061 4159 449352.291904 $199961.7700 $0.4500
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Subtotal (Total Children Is Unduplicated) 9951 32413 555052.824238 $2916580.2000 $5.2500
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Total 34286 557682.850150 $2983936.3300 $5.3500
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Number of Children (Unduplicated) With at Least One Authorization 10326