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: 01-01-19 and 03-31-19 Date of Report: 05-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 62391 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 495 556 900.674604 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 7 43.000000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 506 513 25986.951558 $961517.1300 $37.0000
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Subtotal (Total Children Is Unduplicated) 975 1076 26930.626162 $961517.1300 $35.7000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 216 273 192.422247 $9332.4900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 12 12 8.265905 $466.9400 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 7.000000 $137.9700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 779 814 840.324353 $19739.2200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 33 37 24.857687 $344.7800 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 78 81 79.011112 $1872.5700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 21 21 30.021721 $272.6000 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 35 35 41.221722 $1147.2000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 13 15 13.116667 $1112.8200 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 16 16 9.827778 $501.9100 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 47 50 53.728190 $897.2600 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 19 20 23.987506 $537.3200 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 11 13 8.627799 $388.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 26 31 15.532802 $1786.3000 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 1 1 12.857143 $783.7700 $60.9600
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 6 6 72.857144 $3552.5000 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 45 52 33.136451 $1656.8200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 599 625 877.895079 $43894.7300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 5 8.500000 $637.5000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 38 43 49.422145 $3706.6600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 30 42 39.094368 $2932.0800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 6.511111 $488.3300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 36 44 47.438662 $3557.9000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 32 45 55.599771 $3085.7800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 413 414 721.078189 $54080.8500 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 252 253 457.709735 $34328.2500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 69 69 114.221917 $8566.6400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 540 548 830.383545 $46086.3200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 395 474 762.375974 $57178.2400 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.244444 $62.2200 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 5 6 24.247619 $1212.3800 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 32.195238 $1609.7700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 105 124 33.374651 $1703.7500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 11 12 9.609437 $490.5600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 122 131 100.678483 $5139.6300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 554 669 301.170054 $15374.7700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 81 101 30.147346 $1539.0200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 6 6 4.316667 $220.3700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 63 64 69.722544 $3559.3300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 495 618 357.454457 $18248.1000 $51.0500
SCREEN-T1023 SCREENING 68 71 66.644446 $3332.2300 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 21 22 15.763775 $804.7500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 27 30 14.961719 $763.7900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 669 752 357.994644 $18275.6900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 24 24 21.733334 $1109.4900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 80 88 47.154260 $2307.7400 $48.9400
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 1 1 0.261111 $19.7700 $75.7200
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Subtotal (Total Children Is Unduplicated) 4298 6776 6928.700952 $379049.2600 $54.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 229 299 242.560833 $1212807.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 12 16 15.328767 $766.4400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 57 62 63.464455 $3173.2200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 0.746575 $53.4600 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 13 13 24.521603 $1755.9900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 78 81 127.235800 $29264.2100 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1024 1286 991.638857 $49582.2500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 102 106 80.975490 $2024.3900 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3643 4902 8075.952295 $403797.6800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 355 442 608.875804 $15221.9000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1502 2099 3165.214972 $158260.7300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 136 258 288.453576 $7211.3500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1203 1580 2477.388296 $123869.4700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 52 96 146.722223 $3668.0600 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2917 3580 4955.551718 $247777.7400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 324 388 516.961116 $12924.0400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 29 32 194.630953 $14270.3200 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 1.422222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 404 547 9335.612696 $233390.2400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 64.285714 $3214.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 9.633333 $481.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11345 14838 115305.528258 $5765270.3900 $50.0000
INTR -T1013 INTERPRETER 232 294 1844.721184 $92236.0200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6602 10952 70196.861250 $701967.8200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1389 1764 11282.256318 $806003.9900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 472 575 3838.748820 $219576.2300 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1685 2155 14123.202145 $1008961.0400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 249 294 2137.506747 $122179.8000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 1.746575 $113.5300 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 16 20 8.339729 $1901.5200 $228.0100
SENS -V5060 BEHIND EAR HEARING AID 4 4 3.136986 $715.2400 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 7 9 8.238889 $3756.9400 $456.0000
SENS -V5264 EARMOLD 69 78 73.685387 $1326.3400 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2261 2863 20137.685514 $1438635.2100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 9 9 46.071429 $2635.2800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 192 226 1219.770631 $16930.4100 $13.8800
TRAV -TRAVS Travel by mile 2176 4660 524973.752287 $233613.3100 $0.4500
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Subtotal (Total Children Is Unduplicated) 14204 54539 796588.429447 $12939337.4600 $16.2400
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Total 62391 830447.756561 $14279903.8500 $17.2000
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Number of Children (Unduplicated) With at Least One Authorization 14768