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 50677 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 415 465 1269.353965 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 8 36.122221 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 4 2.655555 $98.2500 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 427 477 1308.131741 $98.2500 $0.0800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 262 356 225.756856 $10949.2300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 4 2.455555 $126.0900 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 4.712328 $84.4500 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 170 171 171.266667 $3656.5400 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 11 11 9.223439 $116.3100 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 10 10 6.854641 $147.7200 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 15 16 17.713134 $146.3100 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 14 14 10.363927 $262.3100 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 5 6.468797 $226.2100 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 11 12 7.383334 $569.4800 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.246575 $11.4500 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 10 10 6.399391 $118.7100 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 10 8.433334 $174.4000 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 5 0.847869 $38.1600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 7 2.788965 $320.7400 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 29 35 37.366588 $1868.3400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 701 721 971.981655 $48599.1100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 4 5.505479 $412.9100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 20 20 15.633181 $1172.4800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 21 22 21.864285 $1639.8200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 0.820777 $61.5600 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 19 20 19.127777 $1434.5800 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 32 32 21.249772 $1179.3500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 69 69 98.078081 $7355.8500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 42.004110 $3150.3100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 26 26 31.872604 $2390.4500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 87 87 107.395892 $5960.4700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 36 37 62.170254 $4662.7700 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 0.300000 $15.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.900000 $45.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 47 52 21.085463 $1076.4100 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 7 4.852131 $247.7000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 52 54 46.564383 $2377.1100 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 179 196 95.173745 $4858.6300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 52 58 33.517566 $1711.0600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 8 10 3.597260 $183.6400 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 14 16 9.574582 $488.7800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 112 127 119.179931 $6084.1200 $51.0500
SCREEN-T1023 SCREENING 3 3 2.461111 $123.0600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 1.406849 $21.1000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 3.444444 $175.8400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 9 9 6.661644 $340.0800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 337 382 305.451289 $15593.3100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF
VOICE AND 35 35 15.597131 $796.2300 $51.0500
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 1.246575 $62.3300 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2003 2697 2587.999371 $131160.4800 $50.6800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 84 105 84.136910 $420684.0000 $4999.9900
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 10.766666 $538.3300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 58 64 71.495748 $3574.7900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.294444 $92.6900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 11 12 5.372982 $1235.7700 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1109 1390 1021.756057 $51088.2400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 62 63 36.456289 $911.4200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5471 7941 13635.645243 $681782.5800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 318 385 505.728575 $12643.2200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1819 2516 3794.244722 $189712.1800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 150 266 305.680158 $7642.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1469 1983 3134.116855 $156705.8900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 72 126 176.305553 $4407.6300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4223 5255 7333.915822 $366695.9100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 282 328 463.491272 $11587.2900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 6 7 16.138095 $1183.2400 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 4 2.361111 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 68 94 706.344443 $17658.5900 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 15 15 88.092064 $4404.6100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2752 3571 27945.929824 $1397295.2000 $50.0000
INTR -T1013 INTERPRETER 281 355 1943.882538 $97194.0500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8191 15075 91650.202370 $916501.0900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 497 595 4006.157146 $286199.7100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 44 52 413.069044 $23627.5300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 476 586 4046.780984 $289101.8900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 26 27 274.500000 $15690.4200 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 1.746575 $113.5300 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 0.300000 $34.2000 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 1.147945 $261.7200 $227.9900
SENS -V5060 BEHIND EAR HEARING AID
2 2 3.000000 $684.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID
7 8 5.834171 $2660.4000 $456.0000
SENS -V5264 EARMOLD 16 18 19.670961 $354.0800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 918 1098 7956.996027 $568447.4700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 34.142857 $1952.9700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 27 30 227.380951 $3156.0400 $13.8800
TRAV -TRAVS Travel by mile 2630 5516 560361.103255 $249360.6800 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 14484 47503 730286.187657 $5785183.3300 $7.9200
-------------------------------------------------------------------------------------------------------------------------------------
Total 50677 734182.318769 $5916442.0700 $8.0600
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 15035