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
Eligibility Filter: Program Patients
With the filters selected there were 92162 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 758 834 1401.115855 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 8 27.074602 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1860 2153 99561.710533 $3683782.4500 $37.0000
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Subtotal (Total Children Is Unduplicated) 2511 2998 100992.300990 $3683871.2500 $36.4800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 338 435 327.119794 $15865.3400 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 36 37 45.774516 $2585.8000 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 17 17 34.056023 $671.2500 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1010 1044 1117.605696 $26252.5600 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 64 68 66.928386 $928.3000 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 125 131 134.642062 $3191.0100 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 61 68 61.532496 $558.7200 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 0.650000 $6.4700 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 90 98 95.727407 $2664.1000 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 12 12 12.861111 $494.7700 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 73 78 91.776331 $7786.3000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 35 37 25.440943 $1299.2700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 86 91 86.852175 $1450.4300 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 32 37 33.872831 $758.7500 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 53 64 51.371690 $2311.7200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 42 53 51.572308 $5930.7700 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H2012BA BEHAVIORAL ANALYSIS-PROF 1 1 11.285714 $687.9800 $60.9600
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 2 2 23.714286 $1156.3100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 65 77 62.375456 $3118.7800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 928 983 1571.597687 $78579.9100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 10 12 10.608220 $795.6200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 58 59 85.843152 $6438.2300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 24 25 32.335843 $2425.1900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 17 17 15.486303 $1161.4700 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 57 81 93.260428 $6994.5300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 86 95 109.070607 $6053.3800 $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 685 687 1116.022318 $83701.5800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 319 319 574.922693 $43119.2200 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 179 179 129.480849 $9710.9300 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 890 904 1350.629943 $74959.8800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 592 682 1065.571167 $79917.8300 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 9 10 25.409522 $1270.4700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 14 19 65.117463 $3255.8900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 139 167 52.521436 $2681.2600 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 20 20 14.911871 $761.2500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 142 151 120.312294 $6141.9500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 866 998 593.006908 $30272.9400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 114 129 35.990946 $1837.3500 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 19 19 14.177778 $723.7800 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 69 77 62.520395 $3191.6700 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 697 865 503.016659 $25679.0200 $51.0500
SCREEN-T1023 SCREENING 94 99 106.571424 $5328.5500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 8 7.865079 $117.9800 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 34 35 33.618276 $1716.2200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 42 42 35.293074 $1801.7100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1105 1230 741.977764 $37878.0700 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 28 29 24.938889 $1273.1300 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 108 115 114.941097 $5625.2200 $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
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Subtotal (Total Children Is Unduplicated) 6511 10415 11047.584867 $601533.9700 $54.4500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 371 494 441.264885 $2206329.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 30 33 33.402740 $1670.1300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 91 110 151.594003 $7579.7200 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 1.939682 $138.9000 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 22 23 29.013167 $2077.6400 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 141 150 167.395597 $38500.9900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1477 1775 1723.735243 $86187.0400 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 186 197 166.220093 $4155.5200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4340 5719 10277.889698 $513894.8900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 506 626 861.606361 $21540.1900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2486 3401 5203.914072 $260195.6900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 199 377 516.156357 $12903.9300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1604 2066 3231.215397 $161560.7700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 72 139 251.479373 $6287.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4387 5457 7615.409680 $380770.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 495 592 801.152380 $20028.8100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 19 19 95.180951 $6978.6700 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 635 954 14760.521436 $369013.1700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 1 1 50.714286 $2535.7200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 1 1 4.000000 $200.0000 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15696 20234 159620.290667 $7981022.5600 $50.0000
INTR -T1013 INTERPRETER 288 377 2021.107496 $101055.4200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9477 15949 102769.393987 $1027694.8900 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2269 2828 18262.786434 $1304694.2700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 768 998 6430.457569 $367822.2800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2526 3199 20951.888803 $1496803.3800 $71.4400
PHY -97110HM PT SESSION BY PT ASST 330 438 2842.288590 $162465.3300 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 9 4.775647 $310.4200 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 5 1.156468 $131.8400 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 21 26 13.644750 $3110.9700 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 7 7 7.000000 $1596.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 32 38 39.147109 $17851.1200 $456.0000
SENS -V5264 EARMOLD 119 143 151.542008 $2727.7500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4178 5327 38150.738426 $2725490.1000 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 8 49.305556 $2820.2900 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 308 410 2385.975411 $33117.3400 $13.8800
TRAV -TRAVS Travel by mile 3008 6617 623689.752531 $277541.9700 $0.4500
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Subtotal (Total Children Is Unduplicated) 20996 78749 1023775.056853 $19608804.1500 $19.1500
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Total 92162 1135814.942710 $23894209.3700 $21.0400
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Number of Children (Unduplicated) With at Least One Authorization 21918