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 34398 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 364 398 1394.203965 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 10 11 33.914285 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 372 409 1428.118250 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 195 283 169.294164 $8210.8100 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 126 131 124.633333 $2660.9200 $21.3500
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.216667 $4.6700 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 2 2 1.900000 $15.6900 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.900000 $48.0900 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 1.500000 $115.6900 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.900000 $35.2500 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 1.772222 $36.6500 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.388889 $62.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 1 0.511111 $58.7800 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 3.571429 $446.4300 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 23 27 16.839420 $841.9700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 499 528 694.003001 $34700.1700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.511111 $38.3300 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 23 23 15.305556 $1147.9200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 36 36 13.916669 $1043.7700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.994444 $74.5800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 24 24 16.738890 $1255.4300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 46 46 19.927778 $1105.9900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 13.519177 $1013.9400 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 5.000000 $375.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 7 7 9.576908 $718.2700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 15 15 23.510958 $1304.8600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 12.527548 $939.5700 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 2.700000 $135.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.183333 $9.3600 $51.0400
OCTF -97168 OT RE-EVAL EST PLAN CARE 24 28 22.155720 $1131.0600 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2 2 1.438889 $73.4600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 5 14.646967 $747.7300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 19 19 15.895129 $811.4400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 53 58 33.884332 $1729.8000 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.087671 $4.4800 $51.0700
PSTF -97164 PT RE-EVAL EST PLAN CARE 24 28 8.545816 $436.2700 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 4 4 0.311872 $15.9200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 3.829833 $195.5100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 8.381561 $427.8800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 44 48 41.377190 $2112.3100 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.733333 $26.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 1.511111 $77.1400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.127778 $6.5200 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 130 148 106.914974 $5458.0400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 19 19 7.808294 $398.6100 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.252055 $12.6100 $50.0100
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Subtotal (Total Children Is Unduplicated) 1176 1547 1423.745133 $70114.4000 $49.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 43 54 33.627019 $168136.5000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 2.044444 $102.2200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 33 36 38.994110 $1949.7100 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 8 8 4.708372 $1082.9300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 811 1012 775.166399 $38758.4800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 44 52 40.759498 $1019.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4066 5992 9694.590715 $484729.4900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 262 329 542.305877 $13557.6500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1257 1740 2786.291671 $139314.5300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 100 160 187.763888 $4694.1000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1029 1331 2154.419245 $107720.9800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 56 95 130.538893 $3263.4800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2944 3667 5342.743611 $267137.1300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 208 268 411.732549 $10293.3300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 13.726985 $1006.4600 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 3 3.666667 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 29 143.715078 $3592.8700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 11 15 125.377778 $6268.8900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 457 597 4371.662688 $218583.2500 $50.0000
INTR -T1013 INTERPRETER 194 264 1571.686758 $78584.3900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6218 11636 70394.847066 $703948.7800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 191 235 1663.390476 $118832.6600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 18 26 196.928573 $11264.3100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 206 246 1604.566668 $114630.2100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 26 33 324.714289 $18560.6600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 4 4.035312 $262.3000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.733333 $83.6000 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.049315 $11.2400 $227.9300
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 1 0.511111 $233.0600 $455.9900
SENS -V5264 EARMOLD 6 7 4.720091 $84.9600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 341 412 3027.020625 $216250.4600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 13 14 56.161904 $779.5200 $13.8800
TRAV -TRAVS Travel by mile 2076 4170 471085.490084 $209633.0600 $0.4500
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Subtotal (Total Children Is Unduplicated) 10006 32442 576738.691092 $2944370.1800 $5.1100
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Total 34398 579590.554475 $3014484.5800 $5.2000
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Number of Children (Unduplicated) With at Least One Authorization 10401