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
Eligibility Filter: Program Patients
With the filters selected there were 91287 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 501 555 1205.361887 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 10 12 35.701588 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 13 13 20.388886 $754.3800 $37.0000
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Subtotal (Total Children Is Unduplicated) 524 580 1261.452361 $754.3800 $0.6000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 329 430 264.332680 $12820.2000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 49 55 47.903468 $2459.8500 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 16 18 14.694751 $263.3300 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1273 1348 1357.012918 $28972.2300 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 50 58 55.410736 $698.7300 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 117 129 79.603770 $1715.4800 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 92 102 96.382815 $796.1200 $8.2600
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 0.772223 $7.0000 $9.0600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 95 103 88.433652 $2238.2600 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 21 24 24.135464 $844.0200 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 51 57 42.976183 $3314.7800 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 4 4 1.877169 $87.1400 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 70 75 51.969680 $964.0400 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 38 46 45.578616 $942.5700 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 44 53 48.992968 $2204.6900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 62 74 59.307163 $6820.3300 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 6 6 77.428571 $3775.4200 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 34 44 16.661413 $833.0900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 831 879 1396.893261 $69844.6600 $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 67 81 95.604796 $7170.3900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 41 63 83.798480 $6284.9000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 8.116590 $608.7500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 78 115 108.369183 $8127.7300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 54 76 56.043076 $3110.4000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 653 655 1034.189796 $77564.3000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 308 308 522.022683 $39151.7600 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 136 136 197.739729 $14830.4400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 818 819 1363.155518 $75655.1500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 482 525 752.381473 $56428.6400 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 3 15.047619 $752.3800 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 18 22 100.560318 $5028.0100 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 148 161 61.618651 $3145.6600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 29 30 24.951293 $1273.7700 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 222 239 184.525171 $9420.0300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 836 964 467.295206 $23855.7300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 162 182 97.884424 $4997.0700 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 30 30 21.378454 $1091.3800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 110 121 92.616813 $4728.1100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 779 940 509.863109 $26028.8100 $51.0500
SCREEN-T1023 SCREENING 56 58 47.955176 $2397.7700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 9 11 12.159718 $182.4000 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 22 23 13.353045 $681.6800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 54 55 50.047870 $2554.9500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1418 1633 982.784563 $50171.6200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 181 189 132.621864 $6770.3800 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 36 36 30.748847 $1369.8600 $44.5500
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.068493 $2.4600 $35.9800
VISF -92499 VISION EVALUATION FUNCTIONAL 2 2 0.609666 $30.4900 $50.0000
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Subtotal (Total Children Is Unduplicated) 6791 10995 10840.579125 $573269.4200 $52.8800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 370 464 382.372628 $1911869.0000 $5000.0200
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 23 28 30.966667 $1548.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 130 160 170.372622 $8518.6200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.002740 $0.1900 $70.5500
AUD -92633 AUD REHAB POSTLING HEARING LOSS 15 16 13.259951 $949.5600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 90 100 66.935577 $15395.2800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1326 1650 1362.664394 $68133.5900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 127 133 90.449859 $2261.2500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5681 8154 13353.558852 $667676.9400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 349 410 559.133721 $13978.3200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2001 2773 4447.256683 $222362.5800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 162 292 352.724984 $8818.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1611 2187 3594.806157 $179739.9800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 66 132 166.116668 $4152.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4594 5755 8147.596518 $407378.7700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 302 344 477.563881 $11939.0800 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 45 49 287.779364 $21099.9900 $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 507 795 6591.901574 $164797.5200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 2 65.000000 $3250.0000 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 17 23 149.057936 $7452.9000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15325 20343 157782.280638 $7889113.2700 $50.0000
INTR -T1013 INTERPRETER 290 370 2192.613188 $109630.6500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8789 15479 98231.036967 $982310.2300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2554 3379 21706.335803 $1550700.7500 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 389 500 3437.270241 $196611.7900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2781 3649 24441.492967 $1746100.3200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 158 194 1738.119445 $99350.8700 $57.1600
RSPT -RSPT RESPITE 2 2 13.428572 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 15 18 7.122450 $462.9700 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 6 9 3.777396 $430.6200 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 25 28 16.730518 $3814.5500 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 12 13 14.895585 $3396.1700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 38 45 58.623527 $26732.4100 $456.0000
SENS -V5264 EARMOLD 123 157 193.608612 $3484.9600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4599 6007 42627.293813 $3045293.8200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 16 21 101.714286 $5818.0600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 140 145 1332.405559 $18493.7800 $13.8800
TRAV -TRAVS Travel by mile 2811 5884 620425.072554 $276089.1600 $0.4500
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Subtotal (Total Children Is Unduplicated) 20254 79712 1014653.914326 $19679671.5600 $19.4000
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Total 91287 1026755.945812 $20253695.3600 $19.7300
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Number of Children (Unduplicated) With at Least One Authorization 20935