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: 07-01-17 and 09-30-17 Date of Report: 11-04-17 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 61095 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 371 405 1402.281742 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 10 11 33.914285 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 10 12 13.144445 $486.3500 $37.0000
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Subtotal (Total Children Is Unduplicated) 389 428 1449.340472 $486.3500 $0.3400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 216 314 184.341272 $8940.5900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 24 26 24.187299 $1242.0100 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 10 12 8.122222 $145.5500 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 702 741 734.670631 $15685.2100 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 12 16 10.431888 $131.5500 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 107 111 86.151260 $1856.5600 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 40 43 21.029909 $173.7100 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 4 2.327778 $21.0900 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 46 50 38.869918 $983.8000 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 11 12 9.550000 $333.9600 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 17 21 8.657686 $667.7700 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 5 5 8.075539 $374.8600 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 31 32 12.657077 $234.7900 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 34 36 27.172222 $561.9200 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 21 23 22.690802 $1021.0900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 22 28 26.094304 $3000.8600 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 3.571429 $446.4300 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 24 29 20.839420 $1041.9700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 499 528 694.003001 $34700.1700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 8 7.548401 $566.1300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 75 102 120.335437 $9025.1500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 54 91 66.662479 $4999.6700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 16 9.126255 $684.4700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 56 81 98.387146 $7379.0100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 77 123 82.842403 $4597.7400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 469 469 633.902119 $47542.7600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 199 199 332.223472 $24916.8000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 119 119 139.283447 $10446.2900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 494 495 885.770071 $49160.2800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 304 315 585.012768 $43876.0100 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 18 25 86.777780 $4338.9000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 9 9 2.266666 $115.7100 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 108 120 65.186223 $3327.7600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 13 13 2.252131 $114.9700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 33 38 37.579084 $1918.4200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 99 104 72.556926 $3704.0400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 489 564 301.927906 $15413.4300 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 4 4 0.454337 $23.1900 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 95 107 89.273147 $4557.4000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 22 22 5.544901 $283.0700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 18 21 12.223440 $624.0100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 54 54 53.891586 $2751.1800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 436 509 277.111976 $14146.5700 $51.0500
SCREEN-T1023 SCREENING 44 47 39.244597 $1962.2300 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 7 6.333333 $95.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 11 11 41.861187 $2137.0100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 17 17 18.084409 $923.2100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 793 902 680.768608 $34753.2800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 91 93 40.218318 $2053.1400 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.252055 $12.6100 $50.0100
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Subtotal (Total Children Is Unduplicated) 4114 6718 6738.346265 $368013.2600 $54.6100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 227 299 192.143600 $960722.5000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 10 9.333333 $466.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 57 65 82.692522 $4134.6300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 11 11 11.561904 $827.9500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 61 63 33.701371 $7751.3700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 933 1154 909.253618 $45462.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 98 109 75.345271 $1883.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4111 6047 9755.062143 $487753.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 264 332 543.739211 $13593.4800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1268 1752 2795.675005 $139783.7000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 100 160 187.763888 $4694.1000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1066 1376 2194.796227 $109739.8200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 56 95 130.538893 $3263.4800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2980 3710 5381.007106 $269050.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 209 269 412.732549 $10318.3300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 18 21 72.961905 $5349.5600 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 3 3.666667 $0.0000 $0.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 2 37.428571 $935.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 393 593 6162.296033 $154057.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 3 157.714285 $7885.7200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 19 25 151.087040 $7554.3600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10628 14109 111816.877910 $5590847.1600 $50.0000
INTR -T1013 INTERPRETER 199 271 1639.401043 $81970.1000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6219 11639 70422.628019 $704226.5900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1507 1933 13160.587736 $940193.0000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 236 292 2031.282934 $116189.4300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1537 2001 13209.513794 $943688.0000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 129 161 1198.868252 $68527.3200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 8 9 4.947640 $321.6100 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 4 3.288889 $374.9300 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 15 18 6.914308 $1576.4400 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
3 5 3.252055 $741.4800 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
8 10 17.328245 $7901.7500 $456.0000
SENS -V5264 EARMOLD 55 70 73.129768 $1316.3400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2380 3082 22284.734404 $1592022.2500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 52.582387 $3007.7200 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 62 70 401.240051 $5569.2100 $13.8800
TRAV -TRAVS Travel by mile 2077 4172 471090.699608 $209635.3800 $0.4500
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Subtotal (Total Children Is Unduplicated) 13254 53949 736717.778185 $12503337.2500 $16.9700
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Total 61095 744905.464922 $12871836.8600 $17.2800
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Number of Children (Unduplicated) With at Least One Authorization 13721