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 33998 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 326 368 1052.901586 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 6 31.265079 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 332 374 1084.166665 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 201 272 177.430753 $8605.4100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.433333 $22.2500 $51.3500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 86 86 85.155556 $1818.0700 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.900000 $11.3500 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 0.927777 $19.9900 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 3 3 2.055556 $16.9800 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 2 2 1.055556 $26.7200 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 5 5 2.650001 $204.4000 $77.1300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 2 2 1.155556 $21.4400 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 1.177778 $24.3600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 0.601294 $27.0600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 3 3 1.394445 $160.3700 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 28 34 35.366588 $1768.3400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 501 520 691.464696 $34573.2600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 11 5.345738 $400.9200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 12 12 16.647618 $1248.5600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.588889 $44.1700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 13 13 10.538889 $790.4200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 20 20 11.015220 $611.3400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 15 24.010958 $1800.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 2.005479 $150.4100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 23.010958 $1277.1100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 7 7 13.500000 $1012.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 20 22 9.411111 $480.4400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 6 2.852131 $145.6000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 17 17 13.528387 $690.6200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 87 92 42.004219 $2144.3200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 21 25 10.182648 $519.8200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 3 4 0.820548 $41.8900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 5 1.723897 $88.0000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 56 60 46.331507 $2365.2200 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.106849 $1.6000 $14.9900
SPCH -92521 EVAL OF SPEECH FLUENCY 3 3 3.000000 $153.1500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 3 3 1.573973 $80.3500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 134 147 82.880112 $4231.0600 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 18 18 6.439422 $328.7300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.246575 $62.3300 $50.0000
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Subtotal (Total Children Is Unduplicated) 1122 1443 1340.834017 $66759.3900 $49.7900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 28 36 30.218493 $151092.0000 $4999.9800
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 2 2 5.866666 $293.3300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 43 47 55.685431 $2784.2800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.294444 $21.0800 $71.6000
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 1.633333 $375.6600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 807 1023 759.591821 $37979.8700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 45 46 26.036955 $650.9300 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4154 5988 9703.137361 $485156.9900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 247 298 396.982541 $9924.5700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1286 1809 2664.751874 $133237.5600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 112 200 225.654761 $5641.3700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1102 1470 2277.367968 $113868.4400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 54 92 127.249998 $3181.2500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3050 3757 5046.715718 $252335.8200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 215 252 340.347617 $8508.6900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 4.266666 $312.8300 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 4 2.361111 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 8 9 88.285715 $2207.1400 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 13 13 77.692064 $3884.6100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 474 582 4479.458335 $223972.7500 $50.0000
INTR -T1013 INTERPRETER 247 315 1617.041266 $80852.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6088 11082 67435.557756 $674354.8900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 220 255 1735.880954 $124011.2500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 32 37 302.019046 $17275.4800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 189 224 1593.995236 $113874.9200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 20 20 201.071430 $11493.2400 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.500000 $32.5000 $65.0000
SENS -V5060 BEHIND EAR HEARING AID
1 1 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
4 4 2.394445 $1091.8900 $456.0100
SENS -V5264 EARMOLD 6 6 2.694445 $48.5000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 367 427 3129.596824 $223578.2400 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 9 11 75.571427 $1048.9300 $13.8800
TRAV -TRAVS Travel by mile 2012 4162 442842.696825 $197064.9900 $0.4500
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Subtotal (Total Children Is Unduplicated) 10039 32181 545255.618526 $2880611.9400 $5.2800
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Total 33998 547680.619208 $2947371.3300 $5.3800
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Number of Children (Unduplicated) With at Least One Authorization 10434