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
Eligibility Filter: Program Patients
With the filters selected there were 86883 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 455 506 1506.175701 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 9 58.976191 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 18 20 19.788891 $732.2000 $37.0000
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Subtotal (Total Children Is Unduplicated) 481 535 1584.940783 $732.2000 $0.4600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 310 399 309.019329 $14987.5200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 39 40 34.287192 $1760.6300 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 14 17 9.166972 $164.2700 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1199 1269 1266.256023 $27034.5700 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 37 43 31.751882 $400.3900 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 125 133 129.896129 $2799.2600 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 95 103 69.150445 $571.1800 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 4 1.727778 $15.6500 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 96 103 68.997151 $1746.3100 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 22 25 19.397338 $678.3300 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 45 50 28.241780 $2178.2800 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 7 8 19.472082 $903.8900 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 58 63 26.515514 $491.8600 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 58 63 52.831585 $1092.5600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 48 57 43.779235 $1970.0700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 66 77 67.814091 $7798.6300 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 5.428571 $678.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 28 32 12.198248 $609.9200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 727 766 1025.896127 $51294.8200 $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 73 95 102.490559 $7686.7800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 50 84 51.672066 $3875.3900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 17 18 13.139879 $985.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 66 92 93.653531 $7024.0100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 88 124 104.385768 $5793.4100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 683 685 964.809556 $72360.8100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 277 277 462.319355 $34674.0200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 209 209 258.126612 $19359.4700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 680 683 975.580018 $54144.7100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 294 297 378.395266 $28379.6500 $75.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 31 44 123.914283 $6195.7200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 152 179 70.150277 $3581.1500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 35 37 27.429910 $1400.3000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 209 218 151.310203 $7724.4100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 830 976 450.555098 $23000.8700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 177 217 161.318553 $8235.3000 $51.0500
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1 1 0.266667 $13.6200 $51.0600
PSTH -97161 PT EVAL LOW COMPLEXITY 27 30 18.788967 $959.1900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 93 99 63.514152 $3242.4000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 712 838 448.878452 $22915.3100 $51.0500
SCREEN-T1023 SCREENING 60 62 57.561338 $2878.0600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 9 13 6.859207 $102.8900 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 27 27 56.829072 $2901.1300 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 23 27 22.682758 $1157.9600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1387 1591 999.074272 $51002.7700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 250 267 157.976027 $8064.6900 $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) 6450 10449 9445.743031 $494991.8400 $52.4000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 341 430 501.862870 $2509320.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 18 26 22.719331 $1135.9700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 155 175 218.064374 $10903.2300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 17 17 19.652719 $1407.3400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 101 110 63.030361 $14496.9500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1294 1604 1346.390000 $67319.8100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 140 146 94.023532 $2350.6000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5593 8124 14092.176630 $704608.7700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 335 417 604.431322 $15110.8100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1849 2530 4092.638782 $204631.9300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 126 229 306.844446 $7671.1200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1508 1972 3210.586922 $160529.3100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 75 141 184.916666 $4622.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4290 5351 7857.428157 $392871.4200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 289 341 519.140482 $12978.5300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 20 21 61.860317 $4535.6000 $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 551 715 8494.393674 $212359.9200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 138.428571 $6921.4300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 18 26 145.194695 $7259.7400 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14402 19100 150157.939182 $7507901.8800 $50.0000
INTR -T1013 INTERPRETER 280 384 1891.199355 $94560.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8293 15195 93545.767315 $935458.2400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2482 3202 21643.718500 $1546227.8200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 318 401 3072.260713 $175733.4200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2550 3313 22004.433765 $1571997.0500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 149 190 1324.353575 $75700.0800 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 17 22 11.092770 $721.0500 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 5 7 4.580669 $522.1900 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 27 29 19.922908 $4542.4200 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
8 8 5.489955 $1251.7400 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
30 38 35.910285 $16375.1400 $456.0000
SENS -V5264 EARMOLD 118 151 164.512004 $2961.2200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4493 5798 42635.730709 $3045898.0800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 13 81.055556 $4636.3800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 125 131 1280.614289 $17774.9300 $13.8800
TRAV -TRAVS Travel by mile 2716 5531 580698.411606 $258410.8200 $0.4500
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Subtotal (Total Children Is Unduplicated) 19250 75899 960609.970657 $19603022.6100 $20.4100
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Total 86883 971640.654471 $20098746.6400 $20.6900
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Number of Children (Unduplicated) With at Least One Authorization 19903