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 51253 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 429 470 1291.325811 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 23 26 132.242061 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 2.588889 $95.7900 $37.0000
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Subtotal (Total Children Is Unduplicated) 452 500 1427.263904 $136.7500 $0.1000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 265 351 357.776678 $17352.2000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 3.898413 $200.1900 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 3.394673 $60.8300 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 122 127 117.166672 $2501.5200 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 5 6 4.734551 $59.7000 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 7 7 5.960579 $128.4500 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 9 10 8.687214 $71.7600 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.177778 $1.6100 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 7 8 5.778538 $146.2500 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 3.211111 $112.2900 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 16 17 9.277779 $715.6000 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.933333 $89.7400 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 5 5 7.414763 $137.5400 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 32 34 25.303118 $523.2600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 9 9 3.317580 $149.2900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 12.017502 $1381.9900 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 23 29 28.204400 $1410.2300 $50.0000
EXIT -EXIT EXIT ASSESSMENT 647 686 860.459484 $43022.9900 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 0.368874 $27.6700 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 35 35 29.585546 $2218.9600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 65 69 29.727792 $2229.6900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 4.480517 $336.0300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 50 51 40.243657 $3018.3200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 81 83 38.494731 $2136.5300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 99 99 81.847935 $6138.6400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 27 28 34.189432 $2564.2100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 42 42 53.060277 $3979.5100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 133 133 108.489039 $6021.1400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 48 48 44.581793 $3343.6600 $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 9 9 3.352437 $171.1500 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 45 50 18.611956 $950.1800 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 31 31 11.373214 $580.6100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 7 8 11.651239 $594.8000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 35 36 25.381659 $1295.7300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 143 157 102.778259 $5246.9100 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 4 4 0.671538 $34.2900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 49 61 35.702500 $1822.6600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 26 27 11.112863 $567.3200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 7 8 5.114612 $261.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 19 19 9.075799 $463.3200 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 85 92 68.510554 $3497.5100 $51.0500
SCREEN-T1023 SCREENING 6 6 4.386910 $219.3500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 4.122222 $61.8300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 2.616667 $133.5800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 4 4 2.850000 $145.4900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 350 393 266.092434 $13584.1300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 36 36 34.225659 $1747.2300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.213699 $10.6900 $50.0000
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Subtotal (Total Children Is Unduplicated) 2061 2863 2545.533536 $131662.9500 $51.7200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 125 147 84.814099 $424070.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 4 4 5.511110 $275.5500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 43 48 47.872951 $2393.6400 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 3.488204 $249.7900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 31 33 32.063854 $7374.7400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1167 1488 1110.712986 $55535.9800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 57 69 41.986166 $1049.6700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5198 7713 13467.368375 $673367.8800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 367 451 763.551937 $19088.7800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1750 2375 4212.461457 $210622.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 113 173 183.329760 $4583.2400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1383 1809 3207.324880 $160365.9900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 63 102 101.116670 $2527.9300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3944 4942 7771.012100 $388549.5800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 283 349 654.315843 $16357.8800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 13.993651 $1026.0300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 83 110 659.373805 $16484.3700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 158.571429 $7928.5700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 12 23 115.992065 $5799.6100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2777 3534 28697.182567 $1434859.1100 $50.0000
INTR -T1013 INTERPRETER 210 277 1644.486429 $82224.3000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8338 15934 95139.252506 $951392.4200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 532 624 4482.871006 $320256.2600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 50 58 481.071430 $27517.2800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 519 623 4315.780152 $308319.2900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 35 46 364.564285 $20838.5100 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 12 12 10.586605 $688.1300 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.126027 $14.3600 $113.9800
SENS -V5050 IN EAR MONAURAL HEARING AID 8 8 9.305707 $2121.6800 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
3 3 4.933333 $1124.7900 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
13 14 11.696500 $5333.5600 $456.0000
SENS -V5264 EARMOLD 34 38 45.683559 $822.3000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1089 1321 9863.557929 $704652.5500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 13.000000 $743.6000 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 40 40 445.876186 $6188.7600 $13.8800
TRAV -TRAVS Travel by mile 2688 5504 568253.495999 $252872.8100 $0.4500
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Subtotal (Total Children Is Unduplicated) 14181 47890 746418.331562 $6117622.2600 $8.2000
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Total 51253 750391.129002 $6249421.9600 $8.3300
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Number of Children (Unduplicated) With at Least One Authorization 14708