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 53009 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 730 802 1357.802362 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 8 27.074602 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 166 179 7189.221447 $266001.1200 $37.0000
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Subtotal (Total Children Is Unduplicated) 896 992 8576.498411 $266089.9200 $31.0300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 293 369 268.982047 $13045.6600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 9 9 6.550837 $370.0500 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 5 5 4.661111 $91.8700 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 295 301 306.191269 $7192.4300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 9 9 8.027777 $111.3400 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 19 21 16.388888 $388.4100 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 19 19 16.279832 $147.8200 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 20 20 18.027777 $501.7100 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 5 4.861111 $187.0100 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 15 15 14.674277 $1244.9700 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 11 11 3.924277 $200.4100 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 20 20 20.943651 $349.7600 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 7 7 4.157610 $93.1300 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 8 9 5.999999 $270.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 5 2.026026 $232.9800 $114.9900
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 2 2 23.714286 $1156.3100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 58 68 54.409549 $2720.4800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 909 961 1536.597687 $76829.9100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 0.315069 $23.6300 $75.0100
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 12 13 11.796120 $884.7200 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 2.486073 $186.4600 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 0.473973 $35.5500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 4.046499 $303.4900 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 26 28 15.031957 $834.2500 $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 98 98 88.713707 $6653.4900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 38 38 54.336396 $4075.2400 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 58 58 4.275356 $320.5900 $74.9800
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 195 195 213.317233 $11839.0400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 75 78 102.157541 $7661.7800 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 10.266665 $513.3300 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 9.200001 $460.0100 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 15 17 8.011111 $408.9700 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 4 4 1.722222 $87.9200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 19 20 23.211644 $1184.9600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 90 101 74.553714 $3805.9500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 16 18 5.372223 $274.2600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 2 2.022222 $103.2300 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 8 9 7.763166 $396.3100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 75 93 76.198041 $3889.9000 $51.0500
SCREEN-T1023 SCREENING 14 14 18.941269 $947.0600 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 3 1.179365 $17.6900 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 4 4 1.679148 $85.7200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 5 5 5.094444 $260.0700 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 162 175 143.743464 $7338.0800 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.527778 $26.9400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 19 20 28.300468 $1385.0300 $48.9400
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
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Subtotal (Total Children Is Unduplicated) 2243 2878 3233.160436 $159246.4300 $49.2500
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 104 133 137.656242 $688283.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 9 10 4.680518 $234.0200 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 33 39 45.378497 $2268.9300 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.428571 $102.3000 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.183333 $13.1300 $71.6000
AUDE -V5160 DISPENSING FEE BINAURAL 30 32 27.766209 $6386.2000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1273 1526 1405.458222 $70273.1600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 86 90 62.916631 $1572.9200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4276 5640 10192.708756 $509635.8400 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 503 623 858.039694 $21451.0200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2436 3348 5137.607067 $256880.3200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 199 377 516.156357 $12903.9300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1557 2011 3175.378888 $158768.9400 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 72 139 251.479373 $6287.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4315 5376 7523.383717 $376169.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 495 592 801.152380 $20028.8100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 8 8 51.542857 $3779.1300 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 67 85 693.476982 $17336.9500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3389 4198 33892.730487 $1694638.3100 $50.0000
INTR -T1013 INTERPRETER 254 334 1857.045592 $92852.3200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9476 15941 102712.822558 $1027129.1700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 314 373 2333.539688 $166708.1100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 91 108 657.399212 $37603.2200 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 405 507 3161.974628 $225891.5400 $71.4400
PHY -97110HM PT SESSION BY PT ASST 24 30 211.257143 $12075.4800 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 2.055099 $133.5800 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 3 0.387975 $44.2300 $114.0100
SENS -V5050 IN EAR MONAURAL HEARING AID 1 1 0.126027 $28.7300 $227.9500
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 9 10 5.429375 $2475.7600 $455.9900
SENS -V5264 EARMOLD 18 20 14.959358 $269.2600 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 756 931 6737.387029 $481319.0100 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 8.676190 $496.2800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 32 34 219.133334 $3041.5700 $13.8800
TRAV -TRAVS Travel by mile 3006 6610 623266.181102 $277353.4800 $0.4500
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Subtotal (Total Children Is Unduplicated) 15461 49139 805968.499091 $6174662.8100 $7.6600
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Total 53009 817778.157938 $6599999.1600 $8.0700
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Number of Children (Unduplicated) With at Least One Authorization 16468