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 34416 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 340 379 1272.200301 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 7 36.731747 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 347 386 1308.932048 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 208 276 174.019174 $8439.9900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $51.3500 $51.3500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 121 125 123.433334 $2635.3000 $21.3500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 2.766666 $22.8500 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.766666 $44.7100 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 5 3.533334 $272.5300 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 3 3 2.766666 $51.3200 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 5 5 4.466666 $92.3700 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 4 1.150001 $51.7500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 1 2 0.511112 $58.7900 $115.0200
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 5.428571 $678.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 18 22 8.737896 $436.9100 $50.0000
EXIT -EXIT EXIT ASSESSMENT 540 568 783.529278 $39176.4500 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 1.094444 $82.0800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 20 20 17.849925 $1338.7600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 20 21 5.783333 $433.7500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.311035 $23.3300 $75.0200
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 19 19 15.227777 $1142.0800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 32 34 13.366589 $741.8400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 11 11 17.010958 $1275.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 10.005479 $750.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 11 11 15.515068 $1163.6300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 13 13 21.008219 $1165.9600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 8 8 11.531888 $864.8900 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 26 32 14.039681 $716.7200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 6 2.995739 $152.9400 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 13 10.840944 $553.4300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 69 74 32.285797 $1648.1800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 23 28 8.427776 $430.2300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 4 5 1.681888 $85.8700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 2.707306 $138.2100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 51 56 26.734128 $1364.7900 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.533333 $23.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 1.177778 $60.1300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 107 122 87.347768 $4459.1000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 34 34 14.868188 $759.0200 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.186301 $9.3200 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1187 1548 1449.640706 $71548.4700 $49.3600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 36 22.489804 $112450.0000 $5000.0400
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 1 1 1.488889 $74.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 45 47 52.354697 $2617.7400 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 3.360274 $772.8700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 812 1023 793.896269 $39694.9900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 40 31.379128 $784.4800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4219 6126 10397.053063 $519852.5200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 256 322 489.172589 $12229.3300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1268 1771 2845.093144 $142254.6400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 99 191 229.038889 $5725.9700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1075 1426 2215.425987 $110771.2700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 57 115 144.166667 $3604.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3045 3798 5315.327599 $265766.3500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 213 258 385.696035 $9642.4100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 2.923810 $214.3700 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 3 5.622222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 13 56.422221 $1410.5600 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 10 17 119.288889 $5964.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 470 577 4440.611104 $222030.7400 $50.0000
INTR -T1013 INTERPRETER 233 320 1562.440625 $78122.0700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6230 11320 69163.899796 $691639.4200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 204 244 1841.945238 $131588.6400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 29 41 309.357144 $17695.2400 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 193 232 1564.369842 $111758.6400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 25 33 264.071428 $15094.3400 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 3 0.694673 $45.1600 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.533333 $60.8000 $113.9900
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
1 2 0.511112 $233.1100 $456.0800
SENS -V5264 EARMOLD 5 6 4.554947 $81.9900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 322 389 2955.280955 $211125.3700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 14 14 192.138096 $2666.8800 $13.8800
TRAV -TRAVS Travel by mile 2057 4105 457654.449858 $203656.2500 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 10203 32482 563065.058327 $2919629.1700 $5.1900
-------------------------------------------------------------------------------------------------------------------------------------
Total 34416 565823.631081 $2991177.6500 $5.2900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 10599