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 52407 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 704 784 1243.994573 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 6 20.050793 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 183 206 10305.952402 $381320.2200 $37.0000
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Subtotal (Total Children Is Unduplicated) 891 1000 11573.653323 $381455.4700 $32.9600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 290 368 264.764075 $12841.0800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 8 9 10.022222 $566.1500 $56.4900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 4 5 2.038889 $40.1900 $19.7100
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 504 522 557.527777 $13096.3300 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 10 13 8.200000 $113.7300 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 13 15 10.250000 $242.9300 $23.7000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 20 25 18.427397 $167.3200 $9.0800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 24 28 23.200000 $645.6600 $27.8300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 5 8 7.022222 $270.1400 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 14 16 11.877397 $1007.6800 $84.8400
AUDE -92586 AUD EVOKED RESPONSE (LIMITED) 3 4 1.710730 $87.3700 $51.0700
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 20 24 18.616666 $310.9000 $16.7000
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 10 13 7.610730 $170.4800 $22.4000
AUDE -V5010 ASSESSMENT FOR HEARING AID 13 15 35.902814 $1615.6200 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 10 7.608522 $874.9500 $115.0000
BEHV -H2014BA BEHAVIOR ANALYSIS-ASSOCIATE 1 1 3.285714 $160.2100 $48.7600
EVAL -96111 DEVELOPMENTAL EVALUATION 43 51 26.979980 $1349.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 808 849 1340.936174 $67046.8100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 9 9 4.849314 $363.7100 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 17 17 12.108296 $908.1300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 6.004110 $450.3100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 2.106850 $158.0100 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 6 7 4.140412 $310.5200 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 44 45 42.324566 $2348.9800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 112 112 103.752063 $7781.3800 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 44 44 71.035616 $5327.6700 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 56 56 14.200012 $1064.9600 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 189 191 212.035231 $11767.9400 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 87 93 132.086307 $9906.4200 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 7 8 29.700001 $1485.0100 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 5 7 11.876191 $593.8200 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 13 15 4.266667 $217.8200 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 3 3 2.116667 $108.0600 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 19 20 23.295292 $1189.2200 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 116 125 86.883998 $4435.4400 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 19 24 9.477778 $483.8400 $51.0500
PSTH -97161 PT EVAL LOW COMPLEXITY 2 3 1.194444 $60.9700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 7 8 4.061796 $207.3500 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 92 108 90.115413 $4600.3800 $51.0500
SCREEN-T1023 SCREENING 20 21 19.423014 $971.1500 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.022222 $15.3300 $15.0000
SPCH -92521 EVAL OF SPEECH FLUENCY 2 2 0.138585 $7.0800 $51.0600
SPCH -92522 EVAL OF SPCH SOUND PROD 6 6 5.361111 $273.6800 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 169 189 144.228016 $7362.8400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 0.178767 $9.1300 $51.0600
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 18 18 22.369515 $1094.7700 $48.9400
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.366667 $18.3400 $50.0000
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Subtotal (Total Children Is Unduplicated) 2360 3120 3416.700230 $164128.7700 $48.0400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 102 127 134.130974 $670656.0000 $5000.0100
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 6 7 4.515220 $225.7600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 33 36 37.501372 $1875.0900 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 1.677778 $120.1500 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 25 26 23.711111 $5453.5500 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1237 1518 1519.441944 $75972.3900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 72 75 80.413973 $2010.3600 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 4284 5466 10158.259920 $507913.1700 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 535 649 942.126201 $23553.1800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2533 3427 5124.518266 $256225.6000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 204 395 596.666684 $14916.7100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1511 1950 3133.500637 $156675.0200 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 66 126 273.340479 $6833.5200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4468 5486 7482.828927 $374141.4700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 525 622 871.098426 $21777.4900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 4.507936 $330.5200 $73.3200
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 49 67 440.536502 $11013.4300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3284 4075 33647.347419 $1682369.1500 $50.0000
INTR -T1013 INTERPRETER 302 354 1967.702893 $98385.1900 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 9493 15588 101754.123512 $1017542.2800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 298 351 2513.287305 $179549.3300 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 101 118 754.169845 $43138.5100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 398 496 3253.360319 $232420.1200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 21 24 208.100000 $11895.0100 $57.1600
RSPT -RSPT RESPITE 1 1 1.000000 $0.0000 $0.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 2.044444 $132.8900 $65.0000
SENS -V5014 *HEARING AID REPAIR BY MANUFACTURER 1 1 1.022222 $116.5300 $114.0000
SENS -V5050 IN EAR MONAURAL HEARING AID 4 4 2.586301 $589.6500 $227.9900
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 6 8 6.274277 $2861.0400 $455.9900
SENS -V5264 EARMOLD 19 22 16.580744 $298.4500 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 700 839 6252.969285 $446712.5500 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 31.285714 $1789.5400 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 31 33 280.923812 $3899.2200 $13.8800
TRAV -TRAVS Travel by mile 3030 6383 583180.267264 $259515.2300 $0.4500
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Subtotal (Total Children Is Unduplicated) 15533 48287 764702.821706 $6111136.0800 $7.9900
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Total 52407 779693.175259 $6656720.3200 $8.5400
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Number of Children (Unduplicated) With at Least One Authorization 16703