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 50929 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 439 488 1472.609033 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 9 58.976191 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 2.355556 $87.1600 $37.0000
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Subtotal (Total Children Is Unduplicated) 450 500 1533.940780 $87.1600 $0.0600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 261 342 284.051062 $13776.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 4.504762 $231.3200 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 1.244749 $22.3100 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 204 212 210.322223 $4490.3800 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 7 4.447793 $56.0900 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 9 9 4.236758 $91.3000 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 18 19 14.781735 $122.1000 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 14 14 8.570624 $216.9200 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 3.058448 $106.9600 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 10 11 6.786226 $523.4300 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 1.314612 $61.0200 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 11 11 4.696347 $87.1100 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 15 16 10.669711 $220.6500 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 5 6 1.571919 $70.7400 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 6 2.965450 $341.0400 $115.0100
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 5.428571 $678.5800 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 22 26 9.006162 $450.3200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 717 756 1007.896127 $50394.8200 $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 26 26 22.359514 $1676.9800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 28 30 9.044445 $678.3400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 2.422070 $181.6700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 27 27 15.941477 $1195.6100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 40 42 23.429070 $1300.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 76 76 60.200001 $4514.9900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 25 25 32.542463 $2440.7000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 49 49 43.727400 $3279.5300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 112 112 96.247943 $5341.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 57 57 63.830515 $4787.3000 $75.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 52 64 24.517457 $1251.6000 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 8 9 5.588966 $285.3200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 44 46 42.573973 $2173.4000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 173 196 83.677535 $4271.7400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 57 70 32.953962 $1682.2700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 9 10 4.697109 $239.8000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 19 20 10.969102 $559.9700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 117 134 81.446814 $4157.8800 $51.0500
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 1.533333 $23.0000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 3.144444 $160.5200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 6.177778 $315.3800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 324 369 260.993105 $13323.6900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 72 75 44.056392 $2249.0800 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.186301 $9.3200 $50.0000
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Subtotal (Total Children Is Unduplicated) 2113 2912 2560.908892 $128223.8300 $50.0700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 78 92 187.343075 $936716.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 3 3.522223 $176.1200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 58 61 79.448347 $3972.4200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.511111 $36.6000 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 15 16 9.423440 $2167.4100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1103 1366 1120.286312 $56014.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 51 53 36.542789 $913.5700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5519 8033 14003.996470 $700199.7500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 334 416 597.859893 $14946.5200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1813 2490 4055.718942 $202785.9400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 125 228 303.944446 $7598.6200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1455 1912 3155.125833 $157756.2600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 75 141 184.916666 $4622.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4208 5259 7769.008314 $388450.4200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 289 341 519.140482 $12978.5300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 6 6 17.750794 $1301.5000 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 3 5.622222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 74 98 647.596826 $16189.9400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 53.571429 $2678.5700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 13 20 133.588889 $6679.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2607 3470 27763.290286 $1388165.3400 $50.0000
INTR -T1013 INTERPRETER 267 366 1787.962848 $89398.1800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8292 15192 93538.214934 $935382.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 470 580 4148.269852 $296352.5100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 44 58 431.150001 $24661.7800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 469 584 3969.119063 $283553.9000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 32 41 324.071428 $18523.9400 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 7 1.794369 $116.6400 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.533333 $60.8000 $113.9900
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.035616 $8.1200 $227.9000
SENS -V5060 BEHIND EAR HEARING AID
1 1 1.166667 $266.0100 $228.0100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
4 6 2.963167 $1351.2600 $456.0200
SENS -V5264 EARMOLD 15 18 27.303283 $491.4600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 889 1081 8303.050004 $593170.2500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 37.412698 $2140.0100 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 36 37 492.704765 $6838.7500 $13.8800
TRAV -TRAVS Travel by mile 2715 5528 580690.859225 $258407.4600 $0.4500
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Subtotal (Total Children Is Unduplicated) 14541 47517 754405.820042 $6415074.2100 $8.5000
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Total 50929 758500.669714 $6543385.2000 $8.6300
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Number of Children (Unduplicated) With at Least One Authorization 15078