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 33652 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 545 609 1016.544705 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 5 10.907936 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 40 46 1474.495244 $54556.3100 $37.0000
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Subtotal (Total Children Is Unduplicated) 593 664 2505.603440 $54691.5600 $21.8300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 210 266 192.772373 $9349.4800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 1.511111 $85.3600 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 435 445 464.422222 $10909.2800 $23.4900
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 1 1 1.000000 $27.8300 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 4.000000 $153.8800 $38.4700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 2.022222 $232.5500 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 37 44 24.330057 $1216.5000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 560 584 930.959809 $46547.9800 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 3 3 0.134932 $10.1200 $74.9800
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 8 8 4.122603 $228.8000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 18 18 33.005479 $2475.4100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 9 9 16.005479 $1200.4100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 6.008219 $450.6200 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 33 35 59.024657 $3275.8700 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 19.502740 $1462.7000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 7 8 29.700001 $1485.0100 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 6 10.442858 $522.1500 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 2 2 0.361111 $18.4300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 0.805555 $41.1200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 37 37 29.871516 $1524.9500 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 3 0.683333 $34.8800 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 19 21 9.296346 $474.5800 $51.0500
SCREEN-T1023 SCREENING 3 3 3.000000 $150.0000 $50.0000
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 49 52 30.055304 $1534.3200 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 3 3 9.428571 $461.4400 $48.9400
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.366667 $18.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 1374 1582 1896.124358 $84748.6700 $44.7000
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 32 41 55.594444 $277972.0000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 5 3.492998 $174.6500 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 20 21 21.096500 $1054.8300 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.166667 $83.5500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 7 7 6.877778 $1581.8900 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 895 1127 1133.518301 $56676.1000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 49 51 66.328660 $1658.2200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3072 3922 7210.700528 $360535.1300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 431 519 771.337313 $19283.4600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1696 2317 3415.855182 $170792.5100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 157 310 472.670653 $11816.8100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1085 1387 2204.415925 $110220.7900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 51 96 221.201593 $5530.0500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3021 3660 4913.368099 $245668.4200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 417 491 705.955570 $17648.9300 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 3.285714 $240.9100 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 7 8 35.799998 $895.0100 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 482 573 4320.793627 $216039.9500 $50.0000
INTR -T1013 INTERPRETER 255 305 1631.361179 $81568.0900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6950 11351 73604.821412 $736048.9800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 54 60 420.553971 $30044.3800 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 28 31 185.600002 $10616.3100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 116 133 727.567069 $51977.3600 $71.4400
PHY -97110HM PT SESSION BY PT ASST 4 5 38.857143 $2221.0800 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 7 7 6.800000 $122.4000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 121 146 984.220100 $70312.6900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 27.142857 $1552.5700 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 9 10 83.923809 $1164.8600 $13.8800
TRAV -TRAVS Travel by mile 2286 4815 456473.184336 $203130.5800 $0.4500
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Subtotal (Total Children Is Unduplicated) 10266 31406 559749.491428 $2686860.4900 $4.8000
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Total 33652 564151.219226 $2826300.7200 $5.0100
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Number of Children (Unduplicated) With at Least One Authorization 11172