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: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Child has a MEDICAID # Filter: Y
Eligibility Filter: Program Patients
With the filters selected there were 29757 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 6.555556 $242.5600 $37.0000
SCONLY-SCONLY *SERVICE COORDINATION ONLY 497 553 1111.556604 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 15.571429 $0.0000 $0.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 25 25 821.644442 $30400.8400 $37.0000
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Subtotal (Total Children Is Unduplicated) 526 584 1955.328031 $30643.3900 $15.6700
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 196 259 253.942666 $12316.2200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 561 587 614.449207 $14433.4100 $23.4900
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 1 1 1.000000 $13.8700 $13.8700
AUDE -92585 AUD EVOKED RESPONSE (COMP) 3 3 4.000000 $339.3600 $84.8400
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $22.4000 $22.4000
EVAL -96111 DEVELOPMENTAL EVALUATION 23 24 15.070779 $753.5500 $50.0000
EVAL -96111GT DEVELOPMENTAL EVALUATION 2 4 8.000000 $400.0000 $50.0000
EXIT -EXIT EXIT ASSESSMENT 478 485 739.175660 $36958.7700 $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 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 10 10 16.241096 $901.3800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 5 5 3.013698 $167.2600 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 8 8 14.505479 $805.0600 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 4.000000 $222.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 5 6 10.505479 $787.9100 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 3 3 9.571428 $478.5700 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 1.466667 $73.3400 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 1 1 0.094444 $4.8200 $51.0300
OCTH -97166 OT EVAL MODERATE COMPLEXITY 3 3 1.500000 $76.5800 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 27 28 13.470246 $687.6600 $51.0500
PSTF -97164 PT RE-EVAL EST PLAN CARE 1 1 0.355556 $18.1500 $51.0600
PSTH -97163 PT EVAL HIGH COMPLEXITY 16 17 9.816668 $501.1500 $51.0500
SCREEN-T1023 SCREENING 1 1 1.000000 $50.0000 $50.0000
SPCH -92522 EVAL OF SPCH SOUND PROD 1 1 0.172222 $8.7900 $51.0400
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 36 37 13.535849 $691.0200 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 5.000000 $222.7500 $44.5500
VISF -92499 VISION EVALUATION FUNCTIONAL 1 1 0.944444 $47.2200 $50.0000
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Subtotal (Total Children Is Unduplicated) 1338 1509 1765.831588 $72738.7800 $41.1900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 25 28 38.523136 $192615.5000 $5000.0000
AUD -92592TS AUDIOLOGY SERVICES (Monaural) 3 3 3.266667 $163.3400 $50.0000
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 13 17 17.911112 $895.5600 $50.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.350000 $25.0600 $71.6100
AUDE -V5160 DISPENSING FEE BINAURAL 5 5 4.466667 $1027.3400 $230.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 719 934 1024.266771 $51213.4400 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 32 33 21.323484 $1066.1900 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 317 344 271.358330 $6784.0100 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 2645 3428 6255.711506 $312785.0500 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 43 53 66.240477 $3312.0300 $50.0000
CONIP -CONIP CONSULT, ITDS PHONE 364 455 691.219048 $17280.4900 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1688 2255 3446.263443 $172312.9500 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 38 41 54.216663 $2710.8200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 142 257 348.363893 $8709.1100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1085 1382 2334.567025 $116728.1500 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 29 32 31.083332 $1554.1600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 50 106 113.959525 $2848.9900 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2804 3459 4570.965771 $228547.8000 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 61 68 69.986507 $3499.3200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 343 418 558.503970 $13962.6100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 4 4 7.528571 $188.2100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 9 37.703175 $1885.1600 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 447 537 4202.622214 $210131.1200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 34 37 309.714284 $15485.7300 $50.0000
INTR -T1013 INTERPRETER 155 193 1299.502382 $64975.1100 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 5897 9640 62210.164992 $622101.6800 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 46 56 394.699206 $28197.2800 $71.4400
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 4.857143 $346.9900 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 31 35 236.714285 $13540.0600 $57.2000
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 10.142857 $724.6100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 81 93 515.903173 $36856.1200 $71.4400
PHY -97110GT PT SESSION BY LICENSED PT 1 1 4.142857 $295.9700 $71.4400
PHY -97110HM PT SESSION BY PT ASST 8 8 53.378571 $3051.1200 $57.1600
PHY -97110TLGT PT SESSION BY LICENSED PT 1 1 1.857143 $132.6700 $71.4400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 1 1 1.000000 $65.0000 $65.0000
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 1 2 1.011112 $461.1100 $456.0400
SENS -V5264 EARMOLD 6 7 6.011112 $108.2000 $18.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 108 124 790.514684 $56474.3700 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 7 7 48.214286 $3444.4300 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 4 31.857144 $1822.2300 $57.2000
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 1 1 1.857143 $132.6700 $71.4400
SPL -92508 GROUP SPL SESSION PER CHILD 7 7 49.749999 $690.5300 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 108 131 787.328173 $29131.1600 $37.0000
TRAV -TRAVS Travel by mile 1732 3444 330308.525151 $146987.2900 $0.4500
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Subtotal (Total Children Is Unduplicated) 8982 27664 421237.546984 $2375270.7200 $5.6400
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Total 29757 424958.706603 $2478652.8900 $5.8300
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Number of Children (Unduplicated) With at Least One Authorization 9957