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
Eligibility Filter: Program Patients
With the filters selected there were 86886 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 434 486 1314.730157 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 8 36.122221 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 20 21 25.911110 $958.7100 $37.0000
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Subtotal (Total Children Is Unduplicated) 462 515 1376.763488 $958.7100 $0.7000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 299 408 247.775269 $12017.1200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 38 40 34.725398 $1783.1500 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 16 16 13.184550 $236.2700 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1228 1291 1293.563547 $27617.5800 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 43 46 43.264208 $545.5600 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 113 122 106.412872 $2293.2000 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 86 92 75.502586 $623.6500 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 3 3 1.822222 $16.5100 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 87 93 73.855271 $1869.2800 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 20 21 21.291019 $744.5500 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 46 49 33.383334 $2574.8600 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 11.532289 $535.3300 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 60 64 42.413425 $786.7700 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 38 39 37.733334 $780.3300 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 46 53 50.583682 $2276.2800 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 62 74 59.498926 $6842.4100 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 41 50 43.521992 $2176.1200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 713 733 995.695941 $49784.8200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 7 10.505479 $787.9100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 81 94 112.204868 $8415.3700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 49 71 90.525731 $6789.4400 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 13 15.837367 $1187.8100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 65 87 97.992315 $7349.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 77 96 88.914154 $4934.7200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 698 701 1122.435791 $84182.7800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 309 309 542.849907 $40713.8000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 158 158 238.286408 $17871.4900 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 744 745 1163.116010 $64552.9600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 331 346 528.553134 $39641.4800 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.566667 $128.3400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 23 31 94.873015 $4743.6600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 146 168 69.474873 $3546.6900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 20 24 17.015601 $868.6500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 224 238 175.891702 $8979.2900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 824 970 437.038840 $22310.9000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 187 204 118.079877 $6027.9600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 32 34 19.061416 $973.0900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 93 99 75.057808 $3831.7100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 712 844 532.880936 $27203.5800 $51.0500
SCREEN-T1023 SCREENING 43 46 40.179529 $2008.9800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 9 11 4.746119 $71.1900 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 24 24 18.222373 $930.2500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 37 38 45.341235 $2314.6800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1411 1612 1031.751953 $52670.9900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 221 231 125.887441 $6426.5700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 4 4 3.422222 $152.4600 $44.5500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.246575 $8.8700 $35.9800
VISF -92499 VISION EVALUATION FUNCTIONAL 3 3 1.429908 $71.5000 $50.0000
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Subtotal (Total Children Is Unduplicated) 6507 10409 10011.149119 $533325.2700 $53.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 344 447 339.331209 $1696659.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 20 23 29.184018 $1459.2000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 142 168 177.064460 $8853.2500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 19 19 23.480810 $1681.4500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 89 99 60.556694 $13928.0200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1269 1589 1203.740213 $60187.4700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 121 123 80.726385 $2018.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5547 8026 13719.482546 $685974.4600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 321 388 512.707939 $12817.7100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1866 2569 3842.660595 $192132.9800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 151 268 308.763491 $7719.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1512 2029 3174.847297 $158742.4100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 72 126 176.305553 $4407.6300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4309 5349 7417.142806 $370857.2700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 284 330 464.902383 $11622.5700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 32 36 97.964284 $7182.7500 $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 500 645 7492.858735 $187321.3300 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 75.428571 $3771.4300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 20 22 98.606350 $4930.3200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 14384 19138 147296.458634 $7364815.5400 $50.0000
INTR -T1013 INTERPRETER 284 360 1982.453967 $99122.6200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8191 15079 91658.102370 $916580.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2504 3230 20845.353368 $1489191.2900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 343 430 3146.589289 $179984.7300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2613 3485 22691.011752 $1621045.2500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 137 171 1239.845234 $70869.5400 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 13 15 9.111414 $592.2500 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 9 5.121919 $583.9100 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 21 26 9.676864 $2206.3300 $228.0000
SENS -V5060 BEHIND EAR HEARING AID
11 12 11.642465 $2654.4900 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
38 46 54.382486 $24798.5100 $456.0000
SENS -V5264 EARMOLD 114 147 159.158340 $2864.8500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4563 5895 41359.447281 $2954716.8500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 13 95.571427 $5466.6800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 112 124 935.839681 $12989.4400 $13.8800
TRAV -TRAVS Travel by mile 2630 5518 560365.193731 $249362.5000 $0.4500
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Subtotal (Total Children Is Unduplicated) 19111 75962 931215.504243 $18431397.5600 $19.7900
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Total 86886 942603.416850 $18965681.5300 $20.1200
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Number of Children (Unduplicated) With at Least One Authorization 19765