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
Eligibility Filter: Program Patients
With the filters selected there were 91288 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 731 812 1290.694095 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 7 30.050793 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1915 2283 100058.318482 $3702157.4000 $37.0000
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Subtotal (Total Children Is Unduplicated) 2542 3106 101382.718925 $3702292.6600 $36.5200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 333 428 313.989799 $15228.5500 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 57 59 82.961970 $4686.5300 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 11 12 11.178615 $220.3300 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1060 1101 1212.500924 $28481.6500 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 53 57 53.432193 $741.1100 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 111 120 91.669839 $2172.5700 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 63 72 63.806089 $579.3600 $9.0800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 2 2 0.961111 $9.5700 $9.9600
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 95 103 104.360254 $2904.3500 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 11 14 14.022222 $539.4300 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 80 88 95.635462 $8113.7000 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 22 24 18.638888 $951.8800 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 81 88 76.764917 $1281.9700 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 32 36 33.636529 $753.4600 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 65 70 79.983864 $3599.2700 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 45 50 44.872700 $5160.3400 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 46 54 29.985536 $1499.2800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 834 878 1388.364745 $69418.2400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 12 14 11.849314 $888.7100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 68 68 84.268724 $6320.1400 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 21 21 28.134551 $2110.0900 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 13 13 10.121919 $759.1400 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 59 76 111.766137 $8382.4400 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 106 107 107.815285 $5983.6900 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 716 717 1165.960285 $87446.9100 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 315 317 572.126021 $42909.4700 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 234 234 219.983583 $16498.6700 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 931 941 1411.531902 $78339.9400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 546 614 967.128119 $72534.5300 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 10 11 34.128572 $1706.4400 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 15 19 84.133335 $4206.6900 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 123 145 60.878890 $3107.8300 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 19 20 24.433333 $1247.3200 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 144 152 108.982124 $5563.5300 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 984 1103 681.610557 $34796.1800 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 97 110 31.918647 $1629.4600 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 14 16 9.027778 $460.8700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 70 76 78.227754 $3993.5100 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 710 849 552.055754 $28182.4300 $51.0500
SCREEN-T1023 SCREENING 123 130 127.394443 $6369.7200 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 6 17.349208 $260.2400 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 37 38 42.463654 $2167.7700 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 41 42 34.775875 $1775.3000 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1234 1383 868.345666 $44329.0900 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 23 25 19.734322 $1007.4400 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 116 118 160.676601 $7863.5300 $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) 6630 10625 11348.751502 $617455.2600 $54.4100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 373 470 448.453355 $2242270.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 29 35 38.815221 $1940.7700 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 87 103 121.548211 $6077.4400 $50.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 0.450000 $32.2200 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 21 23 35.772069 $2561.6300 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 118 123 135.291867 $31117.1600 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1411 1742 1794.723151 $89736.4300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 164 171 164.872422 $4121.8200 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4332 5525 10222.255952 $511112.9800 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 535 649 942.126201 $23553.1800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2567 3469 5168.585727 $258428.9800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 204 395 596.666684 $14916.7100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1555 2003 3178.634762 $158931.7200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 66 126 273.340479 $6833.5200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4521 5546 7549.711466 $377485.5900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 525 622 871.098426 $21777.4900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 9 9 13.698412 $1004.3600 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 607 807 11561.452365 $289036.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 15787 20017 161950.765390 $8097546.4200 $50.0000
INTR -T1013 INTERPRETER 321 381 2084.450512 $104222.5700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9494 15592 101796.837797 $1017969.4300 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 2332 2897 19663.714393 $1404776.6100 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 820 1033 6928.182546 $396292.2800 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 2532 3213 21296.308075 $1521409.0700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 310 390 2776.040397 $158678.6300 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 4 5 3.512938 $228.3500 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 2 2 1.274277 $145.2700 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 23 24 11.734551 $2675.4400 $228.0000
SENS -V5060 BEHIND EAR HEARING AID 9 9 10.377778 $2366.1400 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 26 29 31.792998 $14497.5600 $456.0000
SENS -V5264 EARMOLD 106 126 124.607000 $2242.9200 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4188 5206 38309.219882 $2736812.6900 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 16 17 150.353967 $8600.2500 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 345 406 2903.675398 $40303.0300 $13.8800
TRAV -TRAVS Travel by mile 3033 6390 584010.981550 $259884.9000 $0.4500
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Subtotal (Total Children Is Unduplicated) 21372 77557 985172.326219 $19809589.9700 $20.1100
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Total 91288 1097903.796646 $24129337.8900 $21.9800
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Number of Children (Unduplicated) With at Least One Authorization 22365