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: 01-01-18 and 03-31-18 Date of Report: 05-05-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 61278 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 332 376 1073.192063 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 6 31.265079 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 12 13 20.788889 $769.1900 $37.0000
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Subtotal (Total Children Is Unduplicated) 350 395 1125.246031 $769.1900 $0.6800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 210 287 184.072837 $8927.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 27 28 20.911112 $1073.7900 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 4 3.433333 $61.5200 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 829 880 885.213547 $18899.3100 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 16 19 16.189182 $204.1400 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 70 76 62.798706 $1353.3100 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 42 45 35.868449 $296.2700 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 44 48 36.868449 $933.1400 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 5 5.000000 $174.8500 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 26 28 16.411112 $1265.8000 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 11.285714 $523.8800 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 31 33 23.611371 $437.9900 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 16 17 15.394445 $318.3600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 18 20 23.540020 $1059.3000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 27 34 27.798012 $3196.7800 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 31 37 36.188811 $1809.4500 $50.0000
EXIT -EXIT EXIT ASSESSMENT 503 522 695.464696 $34773.2600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 7.000000 $525.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 54 64 75.595279 $5669.6500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 34 46 72.609063 $5445.6800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 13.605479 $1020.4100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 44 58 65.228616 $4892.1500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 56 72 62.296345 $3457.4300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 501 504 804.011727 $60300.9700 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 249 249 434.543646 $32590.8200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 102 102 150.913804 $11318.5400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 563 564 886.714639 $49212.6900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 259 270 402.858222 $30214.3600 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 11 13 45.457144 $2272.8600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 98 114 44.656500 $2279.7100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 12 15 9.485464 $484.2300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 142 151 104.977700 $5359.1200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 532 628 283.219010 $14458.3700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 112 122 72.201931 $3685.9100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 21 22 12.756926 $651.2400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 63 67 45.264461 $2310.7500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 498 591 383.009442 $19552.6300 $51.0500
SCREEN-T1023 SCREENING 31 34 29.496804 $1474.8500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 3 1.353424 $20.3000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 21 21 17.135463 $874.7600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 17 17 11.789877 $601.8800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 813 924 543.929226 $27767.6400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 136 145 67.169401 $3429.0100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 3.000000 $133.6500 $44.5500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.246575 $8.8700 $35.9800
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.246575 $62.3300 $50.0000
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Subtotal (Total Children Is Unduplicated) 4342 6903 6753.122539 $365524.5300 $54.1300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 217 291 234.106171 $1170534.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 7 8.633333 $431.6700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 68 81 88.468767 $4423.4600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 12 12 17.659273 $1264.5800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 40 42 24.805326 $5705.2200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 904 1141 879.966696 $43998.6400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 85 87 58.713594 $1467.8400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4203 6044 9762.988949 $488149.5800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 248 299 403.411112 $10085.2800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1311 1837 2686.169334 $134308.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 112 200 225.654761 $5641.3700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1133 1504 2305.442854 $115272.1800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 54 92 127.249998 $3181.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3097 3808 5091.438733 $254571.9800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 217 254 341.758728 $8543.9600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 24 26 74.023807 $5427.4300 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 4 2.361111 $0.0000 $0.0000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 51.428571 $1285.7200 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 377 478 5738.800006 $143469.8900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 11.142857 $557.1500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 17 19 88.006350 $4400.3200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10667 14202 109802.123613 $5490100.7600 $50.0000
INTR -T1013 INTERPRETER 250 320 1655.612695 $82780.5600 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6088 11083 67436.224423 $674361.5600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1559 2005 12825.416475 $916247.2200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 250 317 2353.005960 $134591.8000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1679 2210 14382.385545 $1027477.1100 $71.4400
PHY -97110HM PT SESSION BY PT ASST 106 131 973.764286 $55660.3300 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 6 1.390410 $90.3800 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 11 14 4.624658 $1054.4500 $228.0100
SENS -V5060 BEHIND EAR HEARING AID
6 7 7.336986 $1672.8400 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
14 16 26.924799 $12277.7100 $456.0000
SENS -V5264 EARMOLD 53 72 72.678030 $1308.2100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2429 3130 21549.246065 $1539477.1000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 6 40.714284 $2328.8600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 62 69 524.761905 $7283.6900 $13.8800
TRAV -TRAVS Travel by mile 2012 4162 442842.696825 $197064.9900 $0.4500
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Subtotal (Total Children Is Unduplicated) 13404 53980 702723.137290 $12546611.4900 $17.8500
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Total 61278 710601.505860 $12912905.2100 $18.1700
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Number of Children (Unduplicated) With at Least One Authorization 13883