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: 01-01-20 and 03-31-20 Date of Report: 05-15-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 33736 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 2.533333 $93.7300 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 492 557 1055.644116 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 16.877778 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 35 36 1401.615872 $51859.8000 $37.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 530 600 2476.671099 $51953.5300 $20.9800
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 210 268 229.919034 $11151.1000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 581 593 613.142857 $14402.7200 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.083333 $1.9700 $23.6900
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 2 4.000000 $153.8800 $38.4700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 1 1 1.000000 $84.8400 $84.8400
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.255556 $144.3900 $115.0000
EVAL -96111 DEVELOPMENTAL EVALUATION 28 31 25.693152 $1284.6700 $50.0000
EXIT -EXIT EXIT ASSESSMENT 596 616 954.300705 $47715.0400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 4 5 5.010958 $375.8300 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 2.005479 $150.4100 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 2.175342 $163.1500 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 6 5.268494 $395.1300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 12 12 8.272603 $459.1200 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 16 16 25.012329 $1875.9200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 6 6 12.000000 $900.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 5 5 6.006850 $450.5100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 30 30 42.042463 $2333.3600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 15 16 31.000000 $2325.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 6 6 31.899999 $1595.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 4 4 15.242856 $762.1400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 7.000000 $357.3500 $51.0500
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 1.872223 $95.5800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 35 38 21.496688 $1097.4300 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 2 2 0.777778 $39.7100 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 1 1 2.000000 $102.1000 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 23 29 15.888738 $811.1300 $51.0500
SCREEN-T1023 SCREENING 3 3 3.000000 $150.0000 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.505556 $25.8100 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 48 54 22.916324 $1169.9100 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 2 2 2.000000 $102.1000 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 5.000000 $222.7500 $44.5500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 1559 1768 2103.789317 $91214.4700 $43.3600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 38 42 66.373136 $331865.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 5 6 2.505176 $125.2600 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 15 16 15.524352 $776.2200 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 1.505556 $107.8200 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 5.000000 $1150.0000 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 977 1261 1291.459595 $64573.2300 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 119 129 119.153886 $2978.8500 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2926 3792 6955.335295 $347766.1100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 11 11 3.923809 $196.1900 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 409 530 745.305559 $18632.6400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1755 2407 3585.822922 $179290.8200 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 2 2 0.919047 $45.9500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 162 321 415.134526 $10378.3700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1076 1385 2352.882103 $117643.9000 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 5 5 1.733333 $86.6700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 42 88 168.288892 $4207.2300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2996 3719 4946.835235 $247341.0900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 6 6 1.277777 $63.8900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 397 501 662.107149 $16552.6900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 2 2 13.577778 $339.4500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 7.276190 $363.8100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 536 649 5188.188885 $259409.5000 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 13 13 24.395239 $1219.7700 $50.0000
INTR -T1013 INTERPRETER 244 317 1628.153307 $81407.6700 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 6583 11191 71068.466513 $710684.6700 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 51 59 464.228572 $33164.5100 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 4.000000 $285.7600 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 34 45 273.497620 $15644.0500 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 105 120 670.947622 $47932.5200 $71.4400
PHY -97110HM PT SESSION BY PT ASST 7 9 81.321428 $4648.3400 $57.1600
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $228.0000 $228.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 1 0.677778 $309.0800 $456.0100
SENS -V5264 EARMOLD 10 10 8.933334 $160.8000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 129 153 1030.598813 $73625.9900 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 2 2 2.000000 $142.8800 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 48.571429 $2778.2800 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 12 13 109.383335 $1518.2400 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 58 71 56.019047 $2072.7300 $37.0000
TRAV -TRAVS Travel by mile 2043 4475 413733.101636 $184111.2300 $0.4500
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 9862 31368 515756.425874 $2763894.6600 $5.3600
-------------------------------------------------------------------------------------------------------------------------------------
Total 33736 520336.886290 $2907062.6600 $5.5900
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 10851