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
Eligibility Filter: Program Patients
With the filters selected there were 89743 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 649 730 1073.130158 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 7 43.000000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 642 652 29446.750753 $1089529.6800 $37.0000
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Subtotal (Total Children Is Unduplicated) 1256 1389 30562.880911 $1089529.6800 $35.6500
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 320 418 318.259984 $15435.6200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 15 15 12.375494 $699.0900 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 11 12 14.500000 $285.8000 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1159 1211 1278.033083 $30021.0000 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 54 61 47.795281 $662.9200 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 122 128 133.100000 $3154.4700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 43 45 64.122623 $582.2300 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 68 71 82.723373 $2302.1900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 4 4 4.000000 $153.8800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 33 35 57.451588 $4874.1900 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 31 31 18.688889 $954.4400 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 65 69 79.929777 $1334.8300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 33 36 38.341766 $858.8500 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 36 46 42.483668 $1911.7700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 44 57 34.157990 $3928.1900 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 2 2 13.285714 $809.9000 $60.9600
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 9 9 107.571430 $5245.1700 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 61 71 68.880021 $3444.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 863 916 1283.401654 $64170.0500 $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 53 59 77.360957 $5802.0700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 35 48 50.077701 $3755.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 7 7 6.519331 $488.9500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 53 68 90.371995 $6777.8900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 43 56 75.088583 $4167.4100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 614 615 1062.231808 $79667.3600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 336 337 595.289182 $44646.7300 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 106 106 180.224657 $13516.8400 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 801 811 1197.820001 $66479.0500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 557 662 1065.858161 $79939.4300 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.244444 $62.2200 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 7 8 28.100000 $1405.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 15 18 93.642858 $4682.1500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 149 176 54.635763 $2789.1400 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 22 23 18.175875 $927.8800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 178 190 165.004238 $8423.4500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 795 963 485.154242 $24767.1700 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 126 156 57.432269 $2931.9200 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 11 11 7.813242 $398.8700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 87 90 101.306170 $5171.6700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 703 872 536.497282 $27388.2500 $51.0500
SCREEN-T1023 SCREENING 106 111 103.455557 $5172.7900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 4 5.857143 $87.8600 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 38 40 26.045816 $1329.6500 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 52 58 38.341084 $1957.3100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1149 1308 741.346107 $37845.8300 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 37 39 31.933334 $1630.2000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 129 139 97.775633 $4785.1400 $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) 6443 10220 10703.466879 $578608.9000 $54.0600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 362 472 423.505799 $2117530.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 25 32 33.215524 $1660.7800 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 123 140 132.304298 $6615.2100 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 4 13.151337 $941.7600 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 21 21 31.435910 $2251.1200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 142 152 294.619882 $67762.5300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1455 1786 1433.841437 $71692.5400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 145 149 120.949783 $3023.7500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4997 6750 11269.345793 $563467.2600 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 457 572 768.213901 $19205.3500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2205 3087 4732.818932 $236640.8900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 196 374 418.105163 $10452.6400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1635 2158 3352.831013 $167641.5700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 75 140 209.855557 $5246.3900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4339 5352 7615.751524 $380787.6800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 417 496 671.081754 $16777.0600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 37 40 236.332541 $17327.8800 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 4 4 18.222222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 498 682 11622.461896 $290561.4700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 2 2 128.571428 $6428.5700 $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 15499 20300 157720.877539 $7886035.7300 $50.0000
INTR -T1013 INTERPRETER 281 360 2085.877533 $104293.8300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9025 15111 96071.447649 $960713.3900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2252 2874 18620.987039 $1330282.3900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 674 819 5374.577785 $307425.6000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2603 3385 22070.437516 $1576711.4300 $71.4400
PHY -97110HM PT SESSION BY PT ASST 313 373 2659.097227 $151993.9000 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 9 6.573972 $427.3100 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 4 5 3.295890 $375.7300 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 24 28 12.091784 $2757.0200 $228.0100
SENS -V5060 BEHIND EAR HEARING AID 7 7 5.220319 $1190.2300 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 33 42 46.762861 $21323.8800 $456.0000
SENS -V5264 EARMOLD 133 160 162.606621 $2926.9200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4365 5622 39592.752221 $2828504.0800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 12 53.023810 $3032.9600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 289 338 1983.283337 $27527.9600 $13.8800
TRAV -TRAVS Travel by mile 2908 6272 668226.118905 $297360.6100 $0.4500
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Subtotal (Total Children Is Unduplicated) 20471 78134 1058231.281035 $19489379.5700 $18.4200
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Total 89743 1099497.628825 $21157518.1500 $19.2400
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Number of Children (Unduplicated) With at Least One Authorization 21249