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 53290 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 484 537 1167.438080 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 10 12 35.701588 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 1.011111 $37.4100 $37.0000
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Subtotal (Total Children Is Unduplicated) 495 550 1204.150779 $37.4100 $0.0300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 293 382 241.111520 $11693.9600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 7 9 10.052381 $516.1900 $51.3500
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 8 9 5.333640 $95.5800 $17.9200
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 164 169 172.669842 $3686.5000 $21.3500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 13 15 12.172528 $153.5000 $12.6100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 13 15 9.603427 $206.9600 $21.5500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 18 21 28.542467 $235.7600 $8.2600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 17 19 15.036911 $380.5800 $25.3100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 6 7 7.807686 $273.0400 $34.9700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 11 11 8.183335 $631.1900 $77.1300
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 2 2 1.104110 $51.2500 $46.4200
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 10 11 6.879910 $127.6200 $18.5500
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 12 13.344444 $275.9600 $20.6800
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 7 3.404186 $153.1900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 11 14 5.145890 $591.7800 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 2 2 25.428571 $1239.9000 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 29 38 14.563391 $728.1900 $50.0000
EXIT -EXIT EXIT ASSESSMENT 812 859 1365.674083 $68283.7000 $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 17 17 16.755559 $1256.6900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 23 23 20.466593 $1535.0200 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.111111 $8.3300 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 28 30 24.377781 $1828.3600 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 28 28 14.430290 $800.8800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 89 89 105.752048 $7931.4200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 30 30 44.035615 $3302.6800 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 33 33 27.701371 $2077.6000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 142 142 325.235618 $18050.5600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 60 65 78.163469 $5862.2700 $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 44 46 14.104870 $720.0500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 5 5 3.485768 $177.9500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 39 40 39.184204 $2000.3600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 159 178 101.502814 $5181.7600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 51 54 30.565756 $1560.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 5 5 2.849316 $145.4600 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 16 17 10.973745 $560.2100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 136 158 127.715630 $6519.9100 $51.0500
SCREEN-T1023 SCREENING 4 4 3.016667 $150.8400 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 4 1.607382 $24.1100 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 5 5 4.550000 $232.2800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 2.872222 $146.6300 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 326 371 245.096082 $12512.3000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 25 25 12.944448 $660.8300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 3.493303 $155.6300 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.104110 $5.2100 $50.0000
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Subtotal (Total Children Is Unduplicated) 2187 2988 3212.265205 $163068.1200 $50.7600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 99 121 114.409895 $572050.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 8 9 10.577777 $528.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 53 64 70.856087 $3542.8000 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 4.714286 $337.5900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 17 18 11.065072 $2545.0200 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1142 1438 1162.061334 $58103.4200 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 59 59 33.635851 $840.9000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5608 8069 13259.474003 $662972.6700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 348 409 558.776578 $13969.3900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1958 2721 4404.465413 $220223.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 161 291 352.524984 $8813.0900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1561 2124 3546.273398 $177313.3300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 66 132 166.116668 $4152.9200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4526 5681 8091.686280 $404583.2600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 301 343 477.058325 $11926.4400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 21 24 164.567461 $12066.1000 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 93 133 764.886507 $19122.1500 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 11 15 97.222222 $4861.1100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3004 3870 30995.306335 $1549765.1100 $50.0000
INTR -T1013 INTERPRETER 281 357 2141.184616 $107059.2300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8788 15474 98207.508396 $982074.9400 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 476 583 4055.569836 $289729.9200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 58 67 533.999999 $30544.7900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 508 616 4190.312261 $299355.9000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 26 32 276.433333 $15800.9300 $57.1600
RSPT -RSPT RESPITE 1 1 9.571429 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 7 4.033105 $262.1600 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 0.358067 $40.8200 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 6 7 2.158904 $492.2300 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 3 3.175342 $723.9700 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 8 9.238889 $4212.9400 $456.0000
SENS -V5264 EARMOLD 21 27 18.239117 $328.3100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 909 1115 8239.002813 $588594.3000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 4 29.285714 $1675.1500 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 45 45 632.785714 $8783.0700 $13.8800
TRAV -TRAVS Travel by mile 2810 5881 620405.720173 $276080.5500 $0.4500
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Subtotal (Total Children Is Unduplicated) 15413 49752 803044.256184 $6333476.3700 $7.8900
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Total 53290 807460.672168 $6496581.9000 $8.0500
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Number of Children (Unduplicated) With at Least One Authorization 16000