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 50332 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 658 727 1205.375564 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 10 13 78.628570 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 2 3.622222 $134.0200 $37.0000
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Subtotal (Total Children Is Unduplicated) 670 742 1287.626356 $134.0200 $0.1000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 287 377 245.669419 $11915.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 2.799543 $158.1400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 3 4 2.066666 $40.7300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 136 138 136.044444 $3195.6800 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 8 4.266818 $59.1800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 11 11 7.249999 $171.8200 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 12 14 19.280952 $175.0700 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 13 14 20.858730 $580.5000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 1.533333 $58.9900 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 9 10 8.749999 $742.3400 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 1 1 1.000000 $51.0700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 10 11 16.269841 $271.7100 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 6 6 5.405555 $121.0800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 7 3.812329 $171.5600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 8 3.326028 $382.5000 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 13.142857 $640.8500 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 44 58 50.211338 $2510.5700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 742 789 1109.799976 $55490.0100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 26 26 30.638888 $2297.9100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 26 26 16.727777 $1254.5800 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 25 25 28.866667 $2165.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 24 25 17.650000 $979.5700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 43 43 74.027395 $5552.0600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 30 30 54.153815 $4061.5400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 8 8 8.017809 $601.3400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 99 99 133.792952 $7425.5100 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 63 65 109.496672 $8212.2500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 4 4 21.780953 $1089.0500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 30 33 10.655554 $543.9600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 5 3.446499 $175.9400 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 30 30 40.577605 $2071.4900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 111 124 66.009445 $3369.7700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 23 25 9.483331 $484.1100 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 16 17 21.975018 $1121.8300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 107 125 82.296105 $4201.2100 $51.0500
SCREEN-T1023 SCREENING 13 13 10.066666 $503.3300 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 7 7 3.977321 $203.0400 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 2.444445 $124.7900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 223 243 153.209512 $7821.3200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 4 4 3.433333 $175.2700 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 9 3.153197 $154.3200 $48.9400
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Subtotal (Total Children Is Unduplicated) 1855 2456 2558.368786 $131377.0500 $51.3500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 96 114 127.694421 $638472.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 7 5.118721 $255.9400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 57 61 56.751209 $2837.5800 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 3.192172 $228.5900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 18 20 21.265078 $4890.9500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1057 1364 964.047571 $48202.6100 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 63 73 53.985562 $1349.6400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 5190 7050 12395.450903 $619772.6500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 437 558 730.741780 $18268.5500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2012 2816 4662.208971 $233110.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 203 379 433.977764 $10849.4100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1550 2022 3506.091657 $175304.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 72 148 193.194443 $4829.8600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4168 5121 7898.501436 $394925.2100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 384 479 610.298411 $15257.4500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 11 47.001587 $3446.1600 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 13.142857 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 67 88 693.323812 $17333.0900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 2 65.714286 $3285.7200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 9 11 59.422222 $2971.1100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3019 3779 31171.839697 $1558593.2600 $50.0000
INTR -T1013 INTERPRETER 274 328 1928.020403 $96401.0800 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 8936 14743 97792.008322 $977920.9300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 386 459 3139.708740 $224300.9300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 60 68 552.745242 $31617.0500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 415 493 3456.536513 $246935.1300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 26 30 205.092067 $11723.0600 $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 -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 2.413699 $550.3200 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 1.511111 $344.5300 $228.0000
SENS -V5130 IN EAR BINAURAL HEARING AID
1 1 0.060274 $27.5000 $456.2000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 5 5 7.088889 $3232.5400 $456.0000
SENS -V5264 EARMOLD 23 24 18.721764 $336.9900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 796 955 7470.486798 $533691.9000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 8.857143 $506.6300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 30 31 257.302383 $3571.3600 $13.8800
TRAV -TRAVS Travel by mile 2873 5879 682820.332520 $303855.0700 $0.4500
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Subtotal (Total Children Is Unduplicated) 15403 47134 861378.957626 $6189348.5900 $7.1900
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Total 50332 865224.952768 $6320859.6600 $7.3100
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Number of Children (Unduplicated) With at Least One Authorization 16137