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 51775 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 629 709 1004.602382 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 7 43.000000 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 58 59 1259.761900 $46611.1900 $37.0000
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Subtotal (Total Children Is Unduplicated) 687 775 2307.364282 $46611.1900 $20.2000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 284 361 260.346524 $12626.8100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.109589 $62.6800 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 6 5.500000 $108.4100 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 216 219 229.734921 $5396.4700 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 6 7 4.041019 $56.0500 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 12 12 6.638887 $157.3400 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 8 9 19.357143 $175.7600 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 10 11 21.651587 $602.5600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $38.4700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 7 7 16.973810 $1440.0600 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 8 8 2.938889 $150.0900 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 8 9 18.651587 $311.4800 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 5 3.433333 $76.9100 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 8 5.785159 $260.3300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 6 8 4.800988 $552.1000 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 1 1 0.428571 $26.1300 $60.9600
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 4 4 36.714286 $1790.1800 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 52 57 40.830021 $2041.5000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 843 895 1250.242750 $62512.1100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 14 15 17.700000 $1327.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 18 18 16.216667 $1216.2500 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 0.008220 $0.6200 $74.8200
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 17 19 24.850000 $1863.7500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 19 18.838812 $1045.5500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 65 65 81.587669 $6119.0600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 40 40 61.546572 $4616.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 3 3 4.002740 $300.2000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 143 143 159.318648 $8842.1900 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 48 54 90.583560 $6793.7700 $75.0000
NURS -T1001 NURSING ASSESSMENT 1 1 1.244444 $62.2200 $50.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 7 24.814286 $1240.7200 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 1.500000 $75.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 18 23 8.916666 $455.1900 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 1.821766 $93.0000 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 32 34 46.826593 $2390.4900 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 117 134 82.519711 $4212.6400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 19 23 5.766667 $294.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.000000 $102.1000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 10 11 20.294737 $1036.0400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 91 104 84.469615 $4312.1900 $51.0500
SCREEN-T1023 SCREENING 15 15 12.088889 $604.4500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 4.701587 $70.5200 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 9 10 5.404263 $275.8900 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 8 8 4.183333 $213.5600 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 190 211 152.103920 $7764.8900 $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 24 24 18.416666 $901.3100 $48.9400
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Subtotal (Total Children Is Unduplicated) 2041 2624 2883.071762 $144748.4400 $50.2100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 77 103 119.824125 $599120.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 11 5.557838 $277.8900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 51 55 47.534134 $2376.7000 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 12.404762 $888.3000 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.246575 $17.6600 $71.6200
AUDE -V5160 DISPENSING FEE BINAURAL 26 29 36.416199 $8375.7000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1255 1548 1149.319068 $57466.3700 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 68 70 57.670002 $1441.7600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4919 6659 11183.752301 $559187.5700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 455 570 766.642472 $19166.0700 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2153 3028 4656.858863 $232842.8700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 195 373 417.105163 $10427.6400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1588 2100 3305.486821 $165274.3800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 73 137 204.788891 $5119.7300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4268 5276 7522.915723 $376145.8700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 413 492 667.081754 $16677.0600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 12 13 59.793651 $4384.0600 $73.3200
DSTT -DSTT DIRECT SERVICE COORDINATOR TRAVEL 4 4 18.222222 $0.0000 $0.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 52 80 535.706343 $13392.6700 $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 3079 3962 31720.893648 $1586043.3200 $50.0000
INTR -T1013 INTERPRETER 264 337 1984.927532 $99246.3300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9025 15108 96055.790506 $960556.8200 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 346 421 2893.969843 $206745.0200 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 92 103 631.627778 $36129.1000 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 419 522 3287.842039 $234883.3700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 31 34 219.285714 $12534.3700 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 3 3 2.336834 $151.8900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 3 3 2.140334 $243.9900 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 3 3 1.860274 $424.1500 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 0.294444 $67.1200 $227.9700
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 8 9 7.164611 $3267.0100 $455.9900
SENS -V5264 EARMOLD 23 27 21.982495 $395.6800 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 806 986 7049.665072 $503627.7500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 5.666667 $324.1400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 27 31 204.236512 $2834.8000 $13.8800
TRAV -TRAVS Travel by mile 2908 6269 668203.623666 $297350.6000 $0.4500
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Subtotal (Total Children Is Unduplicated) 15417 48376 843131.553923 $6020954.2000 $7.1400
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Total 51775 848321.989967 $6212313.8300 $7.3200
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Number of Children (Unduplicated) With at Least One Authorization 16176