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: 04-01-18 and 06-30-18 Date of Report: 08-10-18 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 64403 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 373 422 1006.857927 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 10 19.844445 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 10 10 17.711109 $655.3000 $37.0000
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Subtotal (Total Children Is Unduplicated) 391 442 1044.413481 $655.3000 $0.6300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 209 281 172.536506 $8368.0500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 32 35 29.830083 $1531.7800 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 6.066666 $108.7100 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 855 911 922.968472 $19705.3800 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 22 24 29.515983 $372.2000 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 76 81 40.600342 $874.9500 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 49 52 47.314698 $390.8200 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 54 56 51.681365 $1308.0600 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 5 6.033333 $210.9800 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 30 33 19.930899 $1537.2800 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 0.633333 $29.4000 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 40 40 30.005065 $556.5900 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 15 16 15.522221 $321.0000 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 17 20 25.215918 $1134.7200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 30 34 32.205719 $3703.6600 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 3 3 39.000000 $1901.6400 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 30 39 15.228079 $761.4200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 594 629 1042.810460 $52140.5300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 1.700000 $127.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 50 62 68.704795 $5152.8800 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 30 45 72.748479 $5456.1500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 6.027701 $452.0800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 54 80 77.285087 $5796.4100 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 42 59 46.416971 $2576.1400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 449 450 717.439576 $53808.0100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 240 240 401.984330 $30148.8800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 82 82 134.032878 $10052.4400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 582 583 871.414421 $48363.5400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 350 381 543.033302 $40727.5100 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.033333 $151.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 10 49.101588 $2455.0800 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 105 116 42.287586 $2158.7900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 18 18 14.223820 $726.1300 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 130 142 101.260201 $5169.3400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 546 631 293.050844 $14960.4300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 98 111 56.714161 $2895.2800 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 21 21 15.111786 $771.4600 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 76 85 61.029835 $3115.5900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 560 676 348.022149 $17766.7600 $51.0500
SCREEN-T1023 SCREENING 44 46 37.427398 $1871.3800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.424657 $6.3700 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 18 19 10.475267 $534.7600 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 37 38 26.150227 $1334.9600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 815 942 542.450741 $27692.3700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 111 117 92.109268 $4702.1800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 19 19 18.099684 $806.3400 $44.5500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.068493 $2.4600 $35.9800
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.104110 $5.2100 $50.0000
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Subtotal (Total Children Is Unduplicated) 4517 7249 7180.031830 $384870.2200 $53.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 222 285 234.629470 $1173150.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 9 9.966667 $498.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 62 77 67.961642 $3398.0700 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.002740 $0.1900 $70.5500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 10 9.241762 $661.8200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 40 44 20.209438 $4648.1900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 970 1230 1037.110499 $51855.8200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 87 91 59.939924 $1498.5100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4234 6095 9431.081590 $471553.4300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 284 334 463.965467 $11599.1100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1382 1940 3004.286059 $150214.0800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 121 230 273.374988 $6834.3500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1198 1634 2594.960209 $129747.8300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 47 97 110.033335 $2750.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3252 4088 5563.609071 $278179.6500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 244 277 381.302771 $9532.5500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 35 39 234.950792 $17226.5900 $73.3200
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 20.571429 $514.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 372 597 4931.986487 $123299.6500 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 15 20 101.905556 $5095.2800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11353 15129 117752.838595 $5887641.3400 $50.0000
INTR -T1013 INTERPRETER 252 320 1920.764852 $96038.2300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6507 11416 72198.181918 $721981.6900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1580 2089 13027.298913 $930670.3200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 280 366 2548.636904 $145781.9800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1794 2326 15575.854516 $1112739.1000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 117 148 1068.227383 $61059.8300 $57.1600
RSPT -RSPT RESPITE 1 1 9.571429 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 7 1.267200 $82.3700 $65.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 13 15 8.991781 $2050.0800 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 7 8 8.517808 $1942.0600 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 13 15 22.653436 $10330.0400 $456.0000
SENS -V5264 EARMOLD 59 76 78.173906 $1407.1300 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2444 3181 21791.425558 $1556779.5800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 13 17 72.357143 $4138.8300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 68 71 656.693652 $9114.9100 $13.8800
TRAV -TRAVS Travel by mile 2143 4428 503232.721099 $223938.5600 $0.4500
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Subtotal (Total Children Is Unduplicated) 14186 56712 778525.265989 $13207954.5900 $16.9700
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Total 64403 786749.711300 $13593480.1100 $17.2800
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Number of Children (Unduplicated) With at Least One Authorization 14671