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 35574 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 369 418 1002.270626 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 8 10 19.844445 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 377 428 1022.115071 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 200 266 163.905227 $7949.4400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.011111 $51.9200 $51.3500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 57 59 62.714286 $1338.9500 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 2 1.011111 $12.7500 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 1.416667 $30.5300 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 2 1.011111 $8.3500 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 2 1.011111 $25.5900 $25.3100
AUDE -92585 AUD EVOKED RESPONSE (COMP) 4 4 2.516667 $194.1100 $77.1300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.722222 $14.9400 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 3 3 1.665982 $74.9700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 5 5 2.490792 $286.4400 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 28 36 14.235613 $711.8000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 591 626 1036.810460 $51840.5300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 0.200000 $15.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 11 11 6.744447 $505.8500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 16 16 17.605481 $1320.4300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.022222 $1.6700 $74.9300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 19 19 10.238891 $767.9300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 19 9.572146 $531.2600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 15 15 24.110958 $1808.3300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 11 11 18.008220 $1350.6200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 3.500000 $262.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 14 14 27.500000 $1526.2500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 12 15 18.528996 $1389.6800 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.033333 $151.6700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.877778 $43.8900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 20 21 7.494443 $382.5800 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 1.329604 $67.8800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 8 8 7.004186 $357.5600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 79 86 39.888587 $2036.3200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 21 22 6.504870 $332.0700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 0.554871 $28.3300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 5 5 3.260427 $166.4500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 71 77 67.926714 $3467.6600 $51.0500
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.249315 $3.7400 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 4.044444 $206.4700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 2 2 0.472222 $24.1100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 132 152 74.389746 $3797.6400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 14 14 6.316668 $322.4700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 1 1 1.000000 $44.5500 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.104110 $5.2100 $50.0000
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Subtotal (Total Children Is Unduplicated) 1182 1535 1652.005039 $83583.4000 $50.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 29 35 42.190639 $210953.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 4.588889 $229.4500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 40 47 44.300530 $2215.0100 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.714286 $265.9800 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 2.105404 $484.2400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 859 1105 909.823682 $45491.4800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 39 39 21.213741 $530.3500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4186 6039 9373.014996 $468650.0800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 283 333 463.608324 $11590.1900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1356 1908 2976.711457 $148835.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 121 230 273.374988 $6834.3500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1158 1582 2553.457610 $127672.6900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 47 97 110.033335 $2750.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3216 4050 5535.617086 $276780.0500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 243 276 380.797215 $9519.9100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 14 17 130.266667 $9551.1600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 21 26 124.471427 $3111.7900 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 10 14 85.088889 $4254.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 519 655 5030.786512 $251539.3200 $50.0000
INTR -T1013 INTERPRETER 244 308 1871.336280 $93566.8100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6507 11415 72195.148585 $721951.3500 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 204 243 1718.923013 $122799.8700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 41 48 392.857142 $22471.4200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 207 239 1652.647221 $118065.1200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 17 21 159.683334 $9127.5000 $57.1600
RSPT -RSPT RESPITE 1 1 9.571429 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 3 0.552131 $35.8900 $65.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 2 2 0.375343 $85.5700 $227.9700
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.175342 $495.9700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 3 1.916667 $874.0200 $456.0100
SENS -V5264 EARMOLD 6 7 3.769178 $67.8500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 350 416 3099.067104 $221397.4000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.642857 $93.9700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 13 13 231.142857 $3208.2700 $13.8800
TRAV -TRAVS Travel by mile 2143 4428 503232.721099 $223938.5600 $0.4500
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Subtotal (Total Children Is Unduplicated) 10544 33611 612638.695259 $3119439.2000 $5.0900
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Total 35574 615312.815369 $3203022.6000 $5.2100
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Number of Children (Unduplicated) With at Least One Authorization 10948