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
Eligibility Filter: Program Patients
With the filters selected there were 85809 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 1 1 2.333333 $86.3300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 487 533 1571.466660 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 11 13 56.403173 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 12 14 14.477778 $535.6800 $37.0000
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Subtotal (Total Children Is Unduplicated) 509 561 1644.680944 $622.0100 $0.3800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 300 415 326.171711 $15819.3900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 35 37 38.491736 $1976.5400 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 18 20 15.074276 $270.1300 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1028 1079 1109.296570 $23683.4700 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 34 40 31.023518 $391.2100 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 147 153 119.403498 $2573.1400 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 85 90 60.333715 $498.3600 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 5 6 4.350000 $39.4100 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 91 96 75.257057 $1904.7600 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 25 26 22.262176 $778.5100 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 37 43 23.547715 $1816.2300 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 9 9 13.394261 $621.7600 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 52 54 28.329680 $525.5100 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 65 69 60.083942 $1242.5300 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 43 50 184.701034 $8311.5500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 58 73 207.609327 $23875.0700 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 3 3 5.571429 $696.4300 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 33 41 26.613164 $1330.6600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 666 705 891.081193 $44554.0800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 9 7.553880 $566.5400 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 97 127 139.697459 $10477.3000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 64 107 76.840102 $5762.9900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 17 19 11.135844 $835.1900 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 77 108 122.815532 $9211.1300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 91 141 99.269494 $5509.4400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 666 666 912.654159 $68449.2200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 271 271 439.315246 $32948.7100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 184 184 212.843715 $15963.3200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 678 679 1114.993664 $61882.1800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 396 409 709.049751 $53178.7900 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.866667 $143.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 35 46 160.272225 $8013.6200 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 10 10 2.433333 $124.2200 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 158 177 81.560423 $4163.6700 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 18 18 3.967320 $202.5300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 45 51 44.927334 $2293.5500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 179 189 138.994826 $7095.6900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 763 877 484.944561 $24756.4200 $51.0500
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 5 5 0.487670 $24.8900 $51.0400
PSTF -97164 PT RE-EVAL EST PLAN CARE 161 184 128.989898 $6584.9400 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 28 28 7.974430 $407.1000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 33 39 23.108219 $1179.6800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 91 93 74.877813 $3822.5400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 633 737 410.608876 $20961.5800 $51.0500
SCREEN-T1023 SCREENING 62 66 57.703349 $2885.1700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 10 13 10.580441 $158.7000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 17 17 44.669101 $2280.3500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 25 25 23.733191 $1211.5800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1380 1579 1218.675740 $62213.4600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 178 182 115.998503 $5921.7300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.585388 $29.2700 $50.0000
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Subtotal (Total Children Is Unduplicated) 6166 10069 10126.724156 $550167.5500 $54.3300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 346 439 550.740708 $2753711.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 23 27 27.458219 $1372.9100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 154 180 210.039227 $10501.9900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 17 17 13.875450 $993.6200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 117 125 80.799002 $18583.8400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1312 1609 1272.819133 $63641.1900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 151 162 104.287416 $2607.2000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5417 7902 13599.839713 $679992.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 350 435 687.418973 $17185.4800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1834 2500 4180.441670 $209022.0200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 126 199 260.483732 $6512.1000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1473 1905 3237.767038 $161888.4400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 70 113 160.505561 $4012.6500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4154 5188 7966.488294 $398324.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 288 361 555.401196 $13885.0300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 21 24 102.523809 $7517.0400 $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 530 805 7977.129373 $199428.1200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 8 306.142856 $15307.1500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 23 29 170.264817 $8513.2400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14104 18706 147871.559341 $7393582.2400 $50.0000
INTR -T1013 INTERPRETER 225 299 1859.615328 $92980.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8229 15567 95024.194554 $950242.3500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2408 3109 21300.387939 $1521700.5800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 325 409 2814.743648 $161003.4000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2433 3182 21224.697144 $1516292.9000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 172 210 1527.132540 $87290.9300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 18 21 12.471538 $810.6700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 7 4.297109 $489.8700 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 32 35 18.378160 $4190.2100 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
10 13 11.034857 $2515.9800 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
34 43 45.348642 $20679.0100 $456.0000
SENS -V5264 EARMOLD 132 169 323.399737 $5821.1900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4405 5740 42118.582047 $3008952.8600 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 8 94.804609 $5422.8300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 131 142 870.625765 $12084.2800 $13.8800
TRAV -TRAVS Travel by mile 2697 5486 588172.373972 $261736.7300 $0.4500
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Subtotal (Total Children Is Unduplicated) 18660 75179 964799.168355 $19619732.0800 $20.3400
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Total 85809 976570.573455 $20170521.6500 $20.6500
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Number of Children (Unduplicated) With at Least One Authorization 19310