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: 10-01-18 and 12-31-18 Date of Report: 02-06-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 61208 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 517 577 1029.393819 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 9 48.409523 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 10 12 15.233333 $563.6300 $37.0000
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Subtotal (Total Children Is Unduplicated) 534 598 1093.036675 $563.6300 $0.5200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 218 294 187.334789 $9085.7500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 17 18 16.585910 $936.9400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 3 3.066667 $60.4400 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 718 748 768.852534 $18060.3500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 23 23 13.966665 $193.7200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 88 90 59.469719 $1409.4300 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 27 28 47.752849 $433.6000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 43 43 58.673398 $1632.8800 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 3.333334 $128.2400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 14 16 8.927778 $757.4300 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 8 8 5.322222 $271.8000 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 38 40 39.511927 $659.8500 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 19 19 16.852969 $377.5100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 13 26.711111 $1202.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 27 30 24.668101 $2836.8200 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 2 2 24.714286 $1205.0700 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 35 49 42.079678 $2103.9800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 529 554 798.236052 $39911.8100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 49 64 71.866663 $5389.9700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 37 55 44.972143 $3372.8900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 9 6.047185 $453.5400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 50 70 79.596650 $5969.7400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 45 65 65.640258 $3643.0400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 354 356 633.288166 $47496.6200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 222 224 414.278729 $31070.9200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 47 47 84.523288 $6339.2500 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 535 535 781.956934 $43398.6400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 442 497 735.162814 $55137.2400 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 18.714286 $935.7200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 12.423810 $621.1900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 113 127 38.487365 $1964.7800 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 11 11 8.174505 $417.3100 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 128 142 102.680441 $5241.8300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 550 647 329.531635 $16822.6100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 90 102 37.471430 $1912.9300 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 10 11 17.771330 $907.2200 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 63 70 75.175030 $3837.6900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 516 636 363.229965 $18542.8400 $51.0500
SCREEN-T1023 SCREENING 66 70 61.244445 $3062.2300 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 16 17 8.866667 $452.6500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 23 24 12.695433 $648.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 750 848 438.817373 $22401.6700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 39 39 28.727092 $1466.5200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 39 44 21.257762 $1040.3600 $48.9400
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Subtotal (Total Children Is Unduplicated) 4213 6698 6639.661388 $363890.1000 $54.8100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 232 304 256.550680 $1282754.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 10 12 12.244445 $612.2300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 65 74 79.721379 $3986.1000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 4 0.337443 $24.1500 $71.5800
AUD -92633 AUD REHAB POSTLING HEARING LOSS 18 19 22.493445 $1610.7700 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 66 68 71.902802 $16537.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 883 1161 853.582621 $42679.2700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 90 92 76.406515 $1910.1700 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3886 5259 8930.302020 $446515.1600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 337 440 575.820354 $14395.5200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1374 1953 3129.424127 $156471.1600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 142 279 308.157926 $7703.9200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1169 1507 2568.442203 $128422.1900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 54 107 132.061109 $3301.5200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2910 3562 5283.869083 $264193.5400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 292 373 473.704761 $11842.6200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 29 32 136.079365 $9977.3300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 452 598 8786.761895 $219669.1700 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 10 11 49.805555 $2490.2800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11564 14909 120565.793189 $6028295.0200 $50.0000
INTR -T1013 INTERPRETER 246 298 1801.304170 $90065.2700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6676 10905 72173.833532 $721738.9300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1448 1788 12209.296872 $872232.6600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 383 466 3194.838117 $182744.8300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1617 2018 14023.938027 $1001870.4700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 184 214 1452.061916 $82999.8800 $57.1600
RSPT -RSPT RESPITE 1 1 3.571429 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 5 6 2.127550 $138.2900 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 12 14 7.649316 $1744.0600 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 5 6 4.837444 $1102.9500 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 8 8 14.779365 $6739.3600 $456.0000
SENS -V5264 EARMOLD 52 67 62.018938 $1116.3400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2235 2720 19799.765181 $1414496.1200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 10 12 64.857145 $3709.8300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 148 157 919.351594 $12760.6000 $13.8800
TRAV -TRAVS Travel by mile 2206 4468 546079.952077 $243005.6000 $0.4500
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Subtotal (Total Children Is Unduplicated) 14332 53912 824127.643590 $13279856.8300 $16.1100
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Total 61208 831860.341653 $13644310.5700 $16.4000
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Number of Children (Unduplicated) With at Least One Authorization 14947