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: 10-01-17 and 12-31-17 Date of Report: 02-03-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 61519 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 350 391 1294.993954 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 7 36.731747 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 12 13 14.966668 $553.7700 $37.0000
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Subtotal (Total Children Is Unduplicated) 369 411 1346.692369 $553.7700 $0.4100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 223 294 182.421002 $8847.4900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 26 26 18.026984 $925.6800 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 4.022222 $72.0800 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 813 858 862.629364 $18417.1300 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 10 10 8.148859 $102.7600 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 81 83 75.323046 $1623.2000 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 42 43 26.549609 $219.3000 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 43 44 25.122363 $635.8500 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 7 7 7.000000 $244.7900 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 19 21 12.300000 $948.7000 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 17.053360 $791.6200 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 32 32 16.679288 $309.4000 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 26 26 22.307764 $461.3300 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 20 23 22.315539 $1004.2100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 25 28 33.462343 $3848.1800 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 5.428571 $678.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 19 23 8.822828 $441.1500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 540 568 783.529278 $39176.4500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 3 1.861111 $139.5800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 52 71 79.038202 $5927.8600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 38 61 35.444288 $2658.3000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 12 13 8.028844 $602.1700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 45 67 78.884429 $5916.3200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 68 102 75.080365 $4166.9600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 466 467 678.997235 $50924.8700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 211 211 362.244018 $27168.3500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 132 132 171.384145 $12853.8100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 488 491 747.308787 $41475.6700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 207 210 263.292529 $19746.9300 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 15 22 60.839681 $3041.9900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 108 126 48.966719 $2499.7500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 24 26 19.390260 $989.8700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 125 131 85.211188 $4350.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 533 629 291.863284 $14899.6500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 103 131 119.292900 $6089.9100 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.266667 $13.6200 $51.0600
PSTH -97161 PT EVAL LOW COMPLEXITY 16 18 11.117277 $567.5500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 56 59 36.848323 $1881.1100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 488 577 315.711461 $16117.1300 $51.0500
SCREEN-T1023 SCREENING 44 45 41.427092 $2071.3500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 5 4.076711 $61.1500 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 19 19 54.235694 $2768.7400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 14 17 15.178648 $774.8700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 774 880 559.951804 $28585.5600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 153 163 73.494902 $3751.9300 $51.0500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.186301 $6.7000 $35.9800
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.186301 $9.3200 $50.0000
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Subtotal (Total Children Is Unduplicated) 4265 6775 6370.951586 $338808.9200 $53.1800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 225 290 226.427329 $1132142.5000 $5000.0300
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 6 6.122223 $306.1200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 72 81 95.584859 $4779.2700 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 11 11 14.574941 $1043.7200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 49 52 29.546345 $6795.6500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 940 1180 943.985931 $47199.4900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 97 99 64.070828 $1601.7700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4262 6182 10453.688777 $522684.3100 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 256 322 489.172589 $12229.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1284 1788 2857.098699 $142854.9200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 99 191 229.038889 $5725.9700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1109 1466 2244.875965 $112243.7600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 57 115 144.166667 $3604.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3090 3847 5359.798235 $267989.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 213 258 385.696035 $9642.4100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 15 15 41.600000 $3050.1100 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 3 5.622222 $0.0000 $0.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 2 52.571428 $1314.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 418 535 6475.504778 $161887.6700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 39.142857 $1957.1400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 15 23 130.894695 $6544.7400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10807 14287 112576.957993 $5628851.6700 $50.0000
INTR -T1013 INTERPRETER 242 333 1626.319989 $81316.0400 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6230 11321 69165.099796 $691651.4200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1564 1998 13446.641094 $960628.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 224 293 2247.501190 $128557.1600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1618 2087 13641.205555 $974527.9900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 118 155 1108.875002 $63383.3200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 7 1.349467 $87.7200 $65.0100
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 2.577777 $293.8600 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 12 13 11.771692 $2683.9500 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
4 4 2.397260 $546.5800 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
10 13 18.355491 $8370.1500 $456.0000
SENS -V5264 EARMOLD 52 66 70.285130 $1265.1300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2439 3108 22572.659626 $1612591.5400 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 16.785714 $960.1400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 65 68 641.495238 $8903.9600 $13.8800
TRAV -TRAVS Travel by mile 2057 4106 457655.649858 $203656.7800 $0.4500
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Subtotal (Total Children Is Unduplicated) 13607 54333 725095.112164 $12813872.9900 $17.6700
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Total 61519 732812.756119 $13153235.6800 $17.9500
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Number of Children (Unduplicated) With at Least One Authorization 14083