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: 07-01-19 and 09-30-19 Date of Report: 11-04-19 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 64113 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
CASE -CASE NON-TCM CASE MANAGEMENT 3 3 2.400000 $88.8000 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 582 638 1164.194430 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 7 19.217459 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1436 1666 79266.454139 $2932858.1700 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1932 2314 80452.266028 $2932946.9700 $36.4600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 221 280 209.735850 $10172.2000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 18 18 27.183572 $1535.6000 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 18.394912 $362.5700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 681 707 742.162046 $17433.3900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 34 36 30.470776 $422.6300 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 63 65 67.880953 $1608.7800 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 25 29 26.445053 $240.1200 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 44 50 50.834180 $1414.7200 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 3 4.000000 $153.8800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 39 41 50.933333 $4321.1800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 18 18 14.361111 $733.4200 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 50 55 50.819635 $848.6900 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 16 18 17.963165 $402.3700 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 25 29 18.944674 $852.5100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 21 25 15.633867 $1797.8600 $115.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 1 1 11.285714 $687.9800 $60.9600
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 13.142857 $640.8500 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 55 65 51.389267 $2569.4700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 671 702 1109.284869 $55464.2600 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 8 8.293151 $621.9800 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 42 42 66.537291 $4990.2900 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 17 17 22.873362 $1715.5100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 12 12 13.012330 $975.9200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 44 62 77.941706 $5845.6200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 60 64 78.400740 $4351.2200 $55.5000
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 1 1 1.500000 $83.2500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 452 453 768.658906 $57649.3600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 232 232 418.602734 $31395.2200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 110 110 102.705494 $7702.8300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 626 638 997.393533 $55355.3200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 435 501 787.259811 $59044.5000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 10.266665 $513.3300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 6 7 13.319048 $665.9600 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 98 115 34.941275 $1783.7800 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 7 7 5.533333 $282.4800 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 92 100 66.115001 $3375.1700 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 599 689 399.287466 $20383.6100 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 70 76 20.457615 $1044.3900 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 15 15 11.638889 $594.1700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 47 53 43.966286 $2244.4800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 484 607 322.426235 $16459.9300 $51.0500
SCREEN-T1023 SCREENING 65 69 68.385710 $3419.2700 $50.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 19 20 23.566906 $1203.1000 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 23 23 17.856164 $911.5500 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 641 709 394.499894 $20139.2700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 16 16 15.511111 $791.8400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 72 77 86.038052 $4210.7000 $48.9400
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.355556 $12.7900 $35.9800
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 3 3 2.044445 $154.8100 $75.7200
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 4382 6882 7410.760099 $409609.3900 $55.2700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 225 299 246.173255 $1230868.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 15 16 12.013852 $600.6900 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 41 46 65.220811 $3261.0500 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 13 14 15.107611 $1081.8600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 93 95 105.624743 $24293.6600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1045 1260 1222.170205 $61108.6500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 132 138 120.646463 $3016.1800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3085 4045 7204.331875 $360216.7500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 395 488 691.724611 $17293.1300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1643 2278 3428.585903 $171429.3000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 151 284 394.029369 $9850.7400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1143 1463 2256.729748 $112836.5000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 52 98 187.857146 $4696.4400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2909 3586 4926.357294 $246317.9100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 386 465 600.799998 $15020.0000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 16 16 86.514284 $6343.2300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 496 753 11424.745242 $285618.7400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 50.714286 $2535.7200 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11451 14811 116837.365723 $5841873.9600 $50.0000
INTR -T1013 INTERPRETER 240 311 1661.942413 $83097.1700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6921 11586 74813.897524 $748139.6300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1421 1749 11192.662328 $799604.3400 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 563 717 4817.797636 $275578.1600 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1608 2015 13026.767029 $930632.4400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 257 342 2161.833031 $123570.4600 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 2 2 1.377778 $89.5600 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 14 16 8.082498 $1842.7900 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 2 2 2.000000 $456.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 14 15 16.016668 $7303.6600 $456.0000
SENS -V5264 EARMOLD 63 73 77.094218 $1387.6900 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2139 2697 18814.340866 $1344097.2300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 29.486509 $1686.6300 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 203 277 1529.104774 $21223.9700 $13.8800
TRAV -TRAVS Travel by mile 2265 4954 492603.590836 $219208.6200 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 14571 54917 770632.706527 $12956180.8400 $16.8100
-------------------------------------------------------------------------------------------------------------------------------------
Total 64113 858495.732654 $16298737.1900 $18.9900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 15249