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: 10-01-19 and 12-31-19 Date of Report: 02-01-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 63803 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 4 4 3.655555 $135.2500 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 558 623 1032.629940 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 5 10.907936 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1469 1764 75434.721597 $2791084.4200 $37.0000
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Subtotal (Total Children Is Unduplicated) 1939 2396 76481.915028 $2791219.6800 $36.5000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 221 282 203.855631 $9887.0300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 25 26 37.132137 $2097.6000 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 2 2 1.139726 $22.4600 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 735 763 822.839204 $19328.4900 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 23 23 18.657915 $258.7900 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 56 59 39.464285 $935.3000 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 24 26 24.248859 $220.1800 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.450000 $4.4800 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 41 42 50.067863 $1393.3900 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 3 4 6.000000 $230.8200 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 44 48 58.444443 $4958.4100 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 13 13 8.650381 $441.7800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 48 49 46.003806 $768.2600 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 13 13 13.734855 $307.6600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 28 28 21.782877 $980.2400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 18 20 12.554794 $1443.8000 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 38 45 26.330057 $1316.5000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 571 596 950.959809 $47547.9800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 5 7 9.005479 $675.4100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 48 48 66.160428 $4962.0100 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 16 16 22.130441 $1659.7800 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 7.015069 $526.1300 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 50 63 89.760657 $6732.0300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 69 69 67.613322 $3752.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 493 494 851.197264 $63839.7100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 234 235 432.573968 $32443.0600 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 166 166 178.291790 $13371.8200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 669 679 1066.015849 $59163.8200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 388 432 692.894455 $51967.0400 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 7 8 29.700001 $1485.0100 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 8 11 33.000002 $1650.0200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 88 100 35.652700 $1820.0300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 12 12 18.805555 $960.0200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 95 101 63.623211 $3247.9600 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 663 744 460.457408 $23506.3300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 57 65 15.768647 $805.0000 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 11 12 7.322223 $373.8000 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 47 49 61.952793 $3162.6900 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 494 592 361.646008 $18462.0300 $51.0500
SCREEN-T1023 SCREENING 84 87 86.815873 $4340.7900 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 0.855556 $12.8300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 24 25 33.741736 $1722.5100 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 20 20 15.657610 $799.3200 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 754 848 513.258562 $26201.8900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 11 12 8.627777 $440.4400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 75 77 121.025981 $5923.0200 $48.9400
VISD -99202 VISION EVAL DIAG (SIMPLE) 1 1 0.511111 $18.3900 $35.9800
VISD -99204 VISION EVAL DIAG (MOD COMPLEXITY) 1 1 1.000000 $75.7200 $75.7200
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.366667 $18.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 4459 7025 7698.050499 $426422.8200 $55.3900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 231 288 264.340647 $1321705.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 13 15 13.548554 $677.4300 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 38 46 55.793328 $2789.6900 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.450000 $32.2200 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 13 14 18.205403 $1303.6900 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 65 65 66.621004 $15322.8300 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1005 1268 1303.781843 $65189.2600 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 112 116 119.205298 $2980.1400 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3101 3956 7248.199735 $362410.1000 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 431 519 771.337313 $19283.4600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1714 2336 3436.248040 $171812.1600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 157 310 472.670653 $11816.8100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1114 1422 2234.300052 $111715.0000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 51 96 221.201593 $5530.0500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3045 3685 4937.701432 $246885.0900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 417 491 705.955570 $17648.9300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 7 7 12.476190 $914.7500 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 469 628 8610.287283 $215257.2900 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 11617 14700 118677.207334 $5933866.2200 $50.0000
INTR -T1013 INTERPRETER 267 322 1703.751655 $85187.6200 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6951 11353 73622.249983 $736223.2600 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 1451 1792 12069.248384 $862227.6600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 605 759 5143.041275 $294182.1500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 1633 2029 13232.245951 $945312.1700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 240 309 2145.700713 $122648.3700 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 12 13 4.767427 $1086.9700 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 3 3 3.000000 $684.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 8 8 10.055555 $4585.3100 $456.0000
SENS -V5264 EARMOLD 49 59 55.855862 $1005.4100 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2168 2647 19066.462315 $1362109.0300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 13 132.579364 $7583.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 237 291 2024.273019 $28096.9100 $13.8800
TRAV -TRAVS Travel by mile 2288 4819 457287.755765 $203493.0600 $0.4500
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Subtotal (Total Children Is Unduplicated) 14910 54382 735672.518540 $13161630.5700 $17.8900
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Total 63803 819852.484067 $16379273.0700 $19.9800
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Number of Children (Unduplicated) With at Least One Authorization 15615