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 33241 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 510 569 1014.962073 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 9 48.409523 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 517 578 1063.371596 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 201 269 168.552218 $8174.8000 $48.5000
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 32 32 32.000000 $751.6800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 0.500000 $6.9400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 1.388889 $32.9200 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 1 1 0.500000 $4.5400 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 0.500000 $13.9200 $27.8300
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.022222 $22.9000 $22.4000
EVAL -96111 DEVELOPMENTAL EVALUATION 35 48 41.735234 $2086.7600 $50.0000
EXIT -EXIT EXIT ASSESSMENT 525 550 792.236052 $39611.8100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 17 17 12.472222 $935.4200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 19 19 6.877777 $515.8300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 19 19 15.244445 $1143.3400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 20 11.227778 $623.1400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 7 7 12.005479 $900.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 8.000000 $600.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 16 16 26.291193 $1459.1600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 18.785714 $1408.9300 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 18.714286 $935.7200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 11 11 4.283332 $218.6600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 9 9 7.622223 $389.1200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 53 56 29.142735 $1487.7200 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 7 7 2.138888 $109.1900 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 1.897185 $96.8500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 48 55 29.903445 $1526.5600 $51.0500
SCREEN-T1023 SCREENING 4 4 2.055556 $102.7800 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 1 0.411111 $20.9900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.027778 $1.4200 $51.0900
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 82 87 49.173614 $2510.3000 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.511111 $26.0900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 1.022222 $50.0300 $48.9400
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Subtotal (Total Children Is Unduplicated) 995 1261 1296.242709 $65767.8900 $50.7400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 29 35 45.547847 $227739.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 2.900000 $145.0000 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 42 44 40.043598 $2002.1900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 3.142857 $225.0600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 2 2 0.555555 $127.7700 $229.9800
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 767 1024 711.594856 $35579.8800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 38 40 34.356991 $858.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3842 5205 8880.197107 $444009.9200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 337 440 575.820354 $14395.5200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1352 1929 3110.501436 $155525.0200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 142 279 308.157926 $7703.9200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1139 1467 2533.382995 $126669.2300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 53 105 126.194443 $3154.8600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2882 3530 5264.656528 $263232.9200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 291 372 472.704761 $11817.6200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 7 23.633333 $1732.7900 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 11 12 95.587300 $2389.6800 $25.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 7 8 42.422222 $2121.1100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 461 528 4268.342058 $213417.2700 $50.0000
INTR -T1013 INTERPRETER 238 286 1710.947027 $85547.4100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6674 10901 72148.501786 $721485.6100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 136 159 1167.392861 $83398.5900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 39 46 384.959527 $22019.6900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 151 178 1247.529366 $89123.5300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 13 16 107.357145 $6136.5300 $57.1600
RSPT -RSPT RESPITE 1 1 3.571429 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 3 0.535769 $34.8300 $65.0000
SENS -V5264 EARMOLD 5 5 2.563622 $46.1400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 267 308 2405.670925 $171861.2700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 3 3 28.571429 $396.5700 $13.8800
TRAV -TRAVS Travel by mile 2205 4465 546052.885410 $242993.5500 $0.4500
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Subtotal (Total Children Is Unduplicated) 10375 31402 651800.228463 $2935891.8800 $4.5000
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Total 33241 654159.842768 $3001659.7700 $4.5900
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Number of Children (Unduplicated) With at Least One Authorization 10910