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
Eligibility Filter: Program Patients
With the filters selected there were 85164 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 2 2 1.107143 $40.9600 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 434 475 1310.592477 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 23 26 132.242061 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 18 20 20.955555 $775.3500 $37.0000
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Subtotal (Total Children Is Unduplicated) 473 523 1464.897236 $816.3200 $0.5600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 309 412 382.728965 $18562.3700 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 39 44 22.739827 $1167.7100 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 26 32 26.632595 $477.2600 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 805 856 760.124614 $16228.6900 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 35 41 31.065092 $391.7300 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 167 173 125.029909 $2694.4200 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 70 76 51.406566 $424.6200 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 12 13 10.352381 $93.7900 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 75 81 67.469939 $1707.6700 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 29 31 31.557936 $1103.5800 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 62 69 33.147114 $2556.6800 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 9 9 7.284018 $338.1200 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 42 48 28.873211 $535.6000 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 84 92 74.584570 $1542.4000 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 42 46 36.607915 $1647.3600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 64 71 66.948172 $7699.0200 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 2.000000 $250.0000 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 4 4 1.638889 $204.8600 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 27 37 34.242754 $1712.1500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 657 696 868.738479 $43436.9300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 9 5.329115 $399.6900 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 94 120 191.165301 $14337.4300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 83 151 106.109525 $7958.3100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 16 12.019330 $901.4500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 92 128 133.708702 $10028.1700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 128 203 141.834346 $7871.8600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 715 716 933.166402 $69987.6100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 300 301 491.585812 $36868.9800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 191 191 240.287743 $18021.6000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 689 695 974.696130 $54095.6500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 353 359 502.529859 $37689.8100 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 0.505556 $25.2800 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 6.633333 $331.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 40 52 168.800000 $8440.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 29 29 10.198788 $520.6700 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 139 153 64.930993 $3314.8300 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 164 164 88.552925 $4520.6600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 39 40 31.852915 $1626.1000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 129 136 99.348324 $5071.7300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 640 710 443.947205 $22663.8300 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 24 24 5.939881 $303.2400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 131 157 71.304155 $3640.2000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 126 127 131.010692 $6688.1300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 29 32 110.341172 $5632.9100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 90 91 57.511201 $2935.9700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 509 596 343.053062 $17513.1500 $51.0500
SCREEN-T1023 SCREENING 80 82 68.288236 $3414.4100 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 9 11 10.187291 $152.8100 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 15 15 7.028692 $358.8100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 25 26 14.049294 $717.2200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1325 1502 1019.077276 $52024.2000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 120 123 88.678194 $4527.0400 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.224810 $61.2400 $50.0000
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Subtotal (Total Children Is Unduplicated) 5944 9798 9238.069206 $505419.6000 $54.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 373 454 376.116787 $1880586.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 28 33 27.203956 $1360.1900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 139 164 162.747195 $8137.3400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 17 17 22.168495 $1587.5000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 108 116 80.535248 $18523.3500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1375 1742 1329.882027 $66494.4000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 149 167 106.607431 $2665.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5297 7824 13593.630279 $679680.9700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 371 457 767.441618 $19186.0200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1794 2423 4256.964633 $212848.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 114 174 184.329760 $4608.2400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1441 1883 3293.331930 $164666.3600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 64 103 101.127781 $2528.2000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4045 5053 7893.866070 $394692.2900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 286 352 658.615843 $16465.3800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 21 25 66.180951 $4852.3900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 497 809 7527.869010 $188196.8400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 7 322.571428 $16128.5800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 21 36 146.680846 $7334.0500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14011 18565 144725.690003 $7236284.5400 $50.0000
INTR -T1013 INTERPRETER 214 284 1678.354683 $83917.7100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8340 15948 95233.100123 $952330.9000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2321 2997 19779.886785 $1413075.1500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 291 352 2549.853168 $145851.6700 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2394 3168 20839.608717 $1488781.6100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 159 201 1178.820237 $67381.3600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 22 23 12.955175 $842.0900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 6 3.663318 $417.6000 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 32 33 24.892846 $5675.5100 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
13 13 15.657687 $3569.9600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
33 38 41.089118 $18736.5800 $456.0000
SENS -V5264 EARMOLD 131 161 186.885009 $3363.9100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4225 5557 39250.795536 $2804076.8000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 11 12 71.285714 $4077.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 124 128 987.692164 $13709.1800 $13.8800
TRAV -TRAVS Travel by mile 2689 5518 568459.053140 $252964.2800 $0.4500
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Subtotal (Total Children Is Unduplicated) 18569 74843 935957.154711 $18185598.1700 $19.4300
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Total 85164 946660.121153 $18691834.0800 $19.7500
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Number of Children (Unduplicated) With at Least One Authorization 19257