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 33897 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 566 621 1152.605542 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 7 19.217459 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 41 45 1504.406356 $55663.0200 $37.0000
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Subtotal (Total Children Is Unduplicated) 615 676 2678.629357 $55751.8200 $20.8100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 210 265 198.691405 $9636.5400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.472222 $83.1600 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 227 232 232.044444 $5450.7200 $23.4900
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.088889 $2.1100 $23.7000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 2.000000 $76.9400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 2 2 1.166667 $98.9800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 3 0.705556 $36.0400 $51.0700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.044444 $0.9900 $22.3800
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 1.022222 $46.0000 $45.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 13.142857 $640.8500 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 50 59 45.805933 $2290.3000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 662 692 1094.284869 $54714.2600 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.001370 $0.1100 $76.6400
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 0.001370 $0.1100 $76.6400
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 1.511111 $113.3300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 7 2.553871 $141.7400 $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 13 13 24.004110 $1800.3100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 12 12 18.016437 $1351.2400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 4 4 2.010959 $150.8200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 30 30 44.591781 $2474.8400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 13 14 23.071233 $1730.3400 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 10.266665 $513.3300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 2 2 6.133334 $306.6700 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 0.605556 $30.9200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 6 6 5.138889 $262.3400 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 29 33 26.852130 $1370.8000 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 3 3 0.333334 $17.0200 $51.0600
PSTH -97162 PT EVAL MODERATE COMPLEXITY 4 4 4.000000 $204.2000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 16 18 7.914231 $404.0300 $51.0500
SCREEN-T1023 SCREENING 2 2 2.000000 $100.0000 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 2.000000 $102.1000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 32 33 21.425190 $1093.7500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 16.620635 $813.4200 $48.9400
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
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Subtotal (Total Children Is Unduplicated) 1277 1465 1813.527270 $86245.6900 $47.5600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 32 45 59.372223 $296861.5000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 7 8 3.424963 $171.2500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 20 22 30.431920 $1521.5900 $50.0000
AUDE -V5160 DISPENSING FEE BINAURAL 11 11 10.699999 $2460.9800 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 920 1109 1031.598640 $51580.0500 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 65 68 52.873519 $1321.8500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3044 3995 7146.355826 $357317.9500 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 395 488 691.724611 $17293.1300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1617 2251 3395.228900 $169761.4400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 151 284 394.029369 $9850.7400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1112 1426 2217.865463 $110893.2900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 52 98 187.857146 $4696.4400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2874 3548 4886.080310 $244304.0700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 386 465 600.799998 $15020.0000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 5 5 42.876190 $3143.6800 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 19 21 281.557936 $7038.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 500 604 4862.734110 $243136.9600 $50.0000
INTR -T1013 INTERPRETER 215 281 1539.237652 $76961.9300 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6920 11583 74802.897524 $748029.6300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 68 74 469.704764 $33555.7000 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 37 39 262.273021 $15001.9900 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 136 168 921.770656 $65851.2500 $71.4400
PHY -97110HM PT SESSION BY PT ASST 5 6 37.428572 $2139.4200 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 0.377778 $24.5600 $65.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 2 2 1.022222 $466.1200 $455.9900
SENS -V5264 EARMOLD 5 5 3.877778 $69.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 162 191 1307.879871 $93434.9500 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 28.857143 $400.5400 $13.8800
TRAV -TRAVS Travel by mile 2263 4951 492215.876550 $219036.0800 $0.4500
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Subtotal (Total Children Is Unduplicated) 10193 31756 597486.714654 $2791345.8100 $4.6700
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Total 33897 601978.871281 $2933343.3100 $4.8700
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Number of Children (Unduplicated) With at Least One Authorization 10941