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 33576 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 487 548 841.547620 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 7 43.000000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 16 17 258.718252 $9572.5800 $37.0000
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Subtotal (Total Children Is Unduplicated) 509 572 1143.265872 $9572.5800 $8.3700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 201 252 175.235413 $8498.9200 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 1 1 1.000000 $19.7100 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 131 132 143.234921 $3364.5900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 0.961110 $22.7800 $23.7000
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 1.172222 $59.8600 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 2 1.000000 $22.4000 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.483333 $21.7500 $45.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 3 3 34.285715 $1671.7700 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 41 45 31.942007 $1597.1000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 595 621 870.895079 $43544.7300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 4.766667 $357.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 14 14 8.233334 $617.5100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 8 5.416667 $406.2500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 12 7.350000 $407.9200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 9 9 13.010958 $975.8300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 17.500000 $1312.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 23 23 38.516437 $2137.6700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 10 18.500000 $1387.5000 $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
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 5 0.888888 $45.3700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 0.032877 $1.6800 $51.0800
OCTH -97166 OT EVAL MODERATE COMPLEXITY 12 13 11.966667 $610.9000 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 50 52 28.882899 $1474.4700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 4 4 0.583333 $29.7800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 3 3 1.691019 $86.3300 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 31 34 21.559471 $1100.6200 $51.0500
SCREEN-T1023 SCREENING 4 4 2.066667 $103.3400 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 1 2 2.000000 $102.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.333333 $17.0200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 52 54 29.065068 $1483.7700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 0.166667 $8.5100 $51.0600
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 8 8 5.611111 $274.6100 $48.9400
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Subtotal (Total Children Is Unduplicated) 1132 1346 1505.843926 $73178.2300 $48.6000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 33 36.930518 $184653.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 8 4.328767 $216.4400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 33 34 23.820011 $1191.0000 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 5 6 5.238889 $1204.9500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 904 1139 809.782557 $40489.4000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 52 54 39.326945 $983.1800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3596 4843 8029.380081 $401469.0600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 354 441 607.875804 $15196.9000 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1474 2064 3132.237441 $156611.8300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 135 257 287.453576 $7186.3500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1174 1541 2450.348866 $122517.5100 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 51 94 142.655557 $3566.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2884 3546 4929.314177 $246465.8500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 320 384 512.961116 $12824.0400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 9 52.576191 $3854.8700 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 1 1 1.422222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 6 9 65.714286 $1642.8500 $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 3 3 6.633333 $331.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 492 602 4900.467473 $245023.1700 $50.0000
INTR -T1013 INTERPRETER 221 282 1768.899755 $88444.9500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6602 10952 70196.861250 $701967.8200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 120 137 971.067458 $69373.0400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 45 48 333.288096 $19064.0800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 173 204 1171.821419 $83714.8900 $71.4400
PHY -97110HM PT SESSION BY PT ASST 11 12 99.000000 $5658.8300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.500000 $32.5000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.483333 $220.3800 $455.9700
SENS -V5264 EARMOLD 8 8 6.344443 $114.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 233 280 1966.348402 $140475.8600 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 23.276191 $323.0700 $13.8800
TRAV -TRAVS Travel by mile 2176 4658 524959.828477 $233607.1100 $0.4500
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Subtotal (Total Children Is Unduplicated) 10219 31658 627601.472348 $2791867.4600 $4.4500
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Total 33576 630250.582146 $2874618.2700 $4.5600
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Number of Children (Unduplicated) With at Least One Authorization 10796