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
Eligibility Filter: Program Patients
With the filters selected there were 87012 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 673 743 1232.307310 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 10 13 78.628570 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 12 14 18.855555 $697.6500 $37.0000
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Subtotal (Total Children Is Unduplicated) 695 770 1329.791435 $697.6500 $0.5200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 329 436 293.218241 $14221.1100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 23 24 19.495042 $1101.2700 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 9 10 7.322222 $144.3200 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1075 1113 1134.437455 $26647.9400 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 48 54 39.085538 $542.1100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 127 130 102.247495 $2423.2600 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 51 58 77.820561 $706.6100 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 76 80 95.702906 $2663.4200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 10 10 9.055556 $348.3700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 34 39 37.084704 $3146.2700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 18 18 13.901369 $709.9400 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 56 60 59.938695 $1000.9800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 31 35 30.073062 $673.6400 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 41 47 58.001219 $2610.0500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 52 57 50.650521 $5824.8000 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 4 4 55.285714 $2695.7400 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 48 64 53.666893 $2683.3400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 759 806 1134.799976 $56740.0100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 2.500000 $187.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 67 83 101.761107 $7632.0500 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 51 72 62.755476 $4706.6400 $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 68 91 112.963316 $8472.2300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 55 78 78.551369 $4359.6000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 516 518 920.359623 $69027.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 293 296 545.948981 $40946.2000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 74 74 121.063013 $9079.7300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 731 732 1089.836775 $60485.9700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 593 669 1010.413496 $75781.0500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 6 34.923810 $1746.1900 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 10 12 61.260318 $3063.0200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 174 194 64.704031 $3303.1400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 22 23 15.828614 $808.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 198 214 175.864512 $8977.8800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 797 932 484.595726 $24738.6500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 136 155 58.465263 $2984.6500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 14 15 20.433126 $1043.1100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 92 100 117.548971 $6000.8800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 722 887 522.242211 $26660.4000 $51.0500
SCREEN-T1023 SCREENING 98 102 98.525396 $4926.2700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 5 15.250467 $228.7600 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 29 30 17.966211 $917.1800 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 43 45 28.895433 $1475.1100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1267 1438 814.611522 $41585.9700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 61 63 54.039400 $2758.7100 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 63 68 34.734692 $1699.9300 $48.9400
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Subtotal (Total Children Is Unduplicated) 6223 9958 9943.877213 $538932.6000 $54.2000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 389 491 437.005210 $2185027.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 26 31 39.416134 $1970.8100 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 142 160 179.663880 $8983.2400 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 4 0.337443 $24.1500 $71.5800
AUD -92633 AUD REHAB POSTLING HEARING LOSS 25 26 24.722365 $1770.3900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 123 132 148.571665 $34171.3800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1248 1591 1212.323820 $60616.4400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 148 161 127.073901 $3176.8600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5252 7127 12474.360576 $623718.1200 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 437 558 730.741780 $18268.5500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2053 2861 4711.549919 $235577.4300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 203 379 433.977764 $10849.4100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1596 2080 3561.661182 $178083.1400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 73 150 199.061109 $4976.5200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4215 5175 7953.370341 $397668.6400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 385 480 611.298411 $15282.4500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 35 40 189.673016 $13906.8200 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 13.142857 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 573 756 11071.641260 $276791.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 4 127.142858 $6357.1400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 13 15 67.805555 $3390.2800 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15620 20171 162682.588053 $8134136.6800 $50.0000
INTR -T1013 INTERPRETER 286 348 2033.229927 $101661.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8940 14751 97837.387687 $978374.7200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2380 2941 20205.288901 $1443466.7400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 527 640 4477.846456 $256132.9800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2514 3185 22316.441237 $1594287.1300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 237 279 1902.514297 $108747.7500 $57.1600
RSPT -RSPT RESPITE 2 2 13.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 8 9 7.490716 $486.9000 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 4 4 3.359665 $382.9900 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 21 24 17.446577 $3977.8500 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 8 9 7.348555 $1675.4800 $228.0000
SENS -V5130 IN EAR BINAURAL HEARING AID
1 1 0.060274 $27.5000 $456.2000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 35 39 57.290628 $26124.4200 $456.0000
SENS -V5264 EARMOLD 114 141 164.492528 $2960.8600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4273 5362 39909.785037 $2851156.5200 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 14 86.857145 $4968.2300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 235 257 1650.511124 $22909.1000 $13.8800
TRAV -TRAVS Travel by mile 2875 5885 682864.018234 $303874.5100 $0.4500
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Subtotal (Total Children Is Unduplicated) 20441 76284 1080551.498087 $19915962.3400 $18.4300
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Total 87012 1091825.166735 $20455592.5900 $18.7400
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Number of Children (Unduplicated) With at Least One Authorization 21263