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 50761 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 478 523 1556.296820 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 11 13 56.403173 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.811111 $30.0100 $37.0000
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Subtotal (Total Children Is Unduplicated) 489 538 1615.844437 $116.3400 $0.0700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 248 347 298.495988 $14477.1000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 8.876985 $455.8300 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.133333 $20.3100 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 186 193 183.327778 $3914.0500 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 4 5 3.659665 $46.1500 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 2.925343 $63.0400 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 13 15 13.162710 $108.7200 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 10 11 7.140487 $180.7300 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 2.456621 $85.9100 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 11 13 8.403196 $648.1400 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 3.066667 $142.3600 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 8 8 7.151598 $132.6600 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 17 18 13.876331 $286.9600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 8 150.136182 $6756.1300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 10 12 157.554903 $18118.8300 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 4.571429 $571.4300 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 27 32 21.214382 $1060.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 659 697 884.125638 $44206.3100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 0.516590 $38.7500 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 30 30 18.585997 $1393.9500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 42 42 15.911113 $1193.3500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 3.004033 $225.3000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 33 33 24.305023 $1822.8800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 52 52 20.954946 $1163.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 54 54 52.628763 $3947.1800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 21 21 23.042463 $1728.2000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 36 36 34.593344 $2594.5100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 97 97 81.661647 $4532.2100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 46 46 48.702886 $3652.7300 $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 2 2 0.350000 $17.8700 $51.0500
OCTF -97168 OT RE-EVAL EST PLAN CARE 50 58 31.255719 $1595.6100 $51.0500
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 4 4 2.477778 $126.4900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 8 9 16.872386 $861.3400 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 48 48 41.861796 $2137.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 147 163 102.734310 $5244.5900 $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 62 71 38.588673 $1969.9600 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 6 6 1.339650 $68.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 8 11 6.715525 $342.8300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 18 18 16.106295 $822.2400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 109 120 96.140397 $4907.9600 $51.0500
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 4.766666 $71.5000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 2.533333 $129.3300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 3.511111 $179.2400 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 354 397 297.812550 $15203.3500 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 59 59 50.272397 $2566.4200 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.252055 $12.6100 $50.0100
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Subtotal (Total Children Is Unduplicated) 2030 2777 2813.564353 $150063.6400 $53.3400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 93 113 250.021235 $1250109.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 6.111111 $305.5600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 47 52 52.001264 $2600.0700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.427549 $30.6100 $71.6000
AUDE -V5160 DISPENSING FEE BINAURAL 25 26 26.655926 $6130.8600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1106 1368 1015.647049 $50782.5700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 61 69 45.438761 $1135.9900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5343 7815 13506.273842 $675313.7800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 347 431 679.771353 $16994.2900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1804 2467 4149.481352 $207474.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 126 199 260.483732 $6512.1000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1420 1837 3162.658311 $158133.0100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 70 113 160.505561 $4012.6500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4078 5099 7889.024799 $394451.2800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 285 358 553.201196 $13830.0300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 37.155556 $2724.2500 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 3 3.666667 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 90 130 756.619841 $18915.4900 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 14 18 143.222222 $7161.1100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2627 3418 27347.514960 $1367376.5400 $50.0000
INTR -T1013 INTERPRETER 216 288 1717.615330 $85880.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8228 15560 94972.713601 $949727.5400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 473 596 4184.063107 $298909.5900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 42 57 400.053573 $22883.0600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 499 613 4059.030170 $289977.0800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 40 47 443.880956 $25372.2400 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 7 6.791477 $441.4500 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.733333 $83.6000 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 2.734703 $623.5100 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
2 2 5.066667 $1155.2100 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
7 8 8.657077 $3947.5900 $456.0000
SENS -V5264 EARMOLD 22 27 180.404826 $3247.2800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 947 1178 8905.980157 $636243.4400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 36.507936 $2088.2600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 45 47 279.757145 $3883.0200 $13.8800
TRAV -TRAVS Travel by mile 2696 5482 588152.254924 $261727.7800 $0.4500
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Subtotal (Total Children Is Unduplicated) 14244 47446 763402.127269 $6770184.6200 $8.8700
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Total 50761 767831.536059 $6920364.6000 $9.0100
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Number of Children (Unduplicated) With at Least One Authorization 14791