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: 07/01/08 and 09/30/08 Date of Report: 11-18-08 Page: 1
Eligibility Filter: Program Patients
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 2 2 1.43 $52.83 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 570 573 651.56 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 24 28 42.14 $1559.29 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 26 26 32.15 $1189.41 $37.00
TCON -TCON TRANSITION CONFERENCE 1 1 1.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 611 630 728.27 $2801.53 $3.85
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 73 81 96.30 $4670.33 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 13 13 17.74 $639.76 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 105 108 108.00 $1146.96 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.00 $16.30 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 104 107 107.00 $944.81 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 105 108 108.00 $1166.40 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 103 106 106.00 $2309.74 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 5 6 6.00 $326.28 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 97 99 99.00 $2799.72 $28.28
AUDE -AUDE UNSPECIFIED AUDE SERVICES 361 392 436.69 $26201.63 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 47 54 57.76 $2702.95 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 255 266 326.13 $39005.63 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 2 2 2.00 $250.00 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 6 7 18.00 $2250.00 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 73 75 172.23 $21528.29 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 322 361 404.47 $20223.25 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 116 136 175.04 $8751.79 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 20 20 20.00 $600.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 3 2.56 $192.08 $75.00
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 2 2 2.50 $138.75 $55.50
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 23 23 29.86 $2239.28 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 5.00 $375.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 9 9 12.27 $920.42 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 26 26 33.00 $2475.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 68 69 90.86 $5042.57 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 35 35 39.50 $2192.25 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 546 546 760.07 $57005.36 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 129 131 191.00 $14325.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 175 177 261.53 $19615.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 481 494 747.07 $41462.47 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 517 573 781.93 $58644.64 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 1 1 1.00 $72.78 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 3 3 3.00 $450.00 $150.00
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 1.00 $50.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 4 4 4.00 $200.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 208 235 280.70 $13614.18 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1028 1137 1242.97 $60283.89 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 226 264 273.84 $13281.11 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 782 869 925.13 $44868.92 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 38 38 38.00 $1900.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2203 2502 2670.31 $129510.06 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 3.00 $300.00 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 14 14 26.14 $1307.15 $50.00
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 1.00 $48.50 $48.50
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Subtotal (Total Children Is Unduplicated) 5180 9107 10689.59 $606075.33 $56.70
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 209 253 423.00 $634500.00 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 2.02 $139.25 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.02 $70.39 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 224 253 536.01 $26800.32 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 893 1898 3631.45 $181572.50 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 44 52 75.96 $1898.88 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2426 2985 5993.88 $299693.90 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 186 199 388.81 $9720.29 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 1165 1425 2508.60 $125430.18 $50.00
CONOP -CONOP CONSULT, OT, PHONE 62 63 94.22 $2355.49 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 851 1044 1851.28 $92564.03 $50.00
CONPP -CONPP CONSULT, PT, PHONE 55 61 116.53 $2913.21 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2503 2995 5397.78 $269889.09 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 210 227 381.29 $9532.22 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 81 85 279.64 $20531.32 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 23 26 3161.86 $39523.21 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 5 5 11.10 $277.50 $25.00
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 1.77 $44.17 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 563 710 4360.15 $109003.63 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 10.71 $535.72 $50.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 20 24 330.86 $16542.86 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 7 7 30.23 $1511.59 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 33 35 289.57 $14478.59 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 26 26 159.23 $7961.67 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 14 15 145.90 $3647.62 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6525 8525 65289.73 $3264486.48 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 13.14 $657.15 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 56 62 302.67 $15133.58 $50.00
INTR -INTR INTERPRETER 103 125 789.17 $39458.26 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 3489 4644 29737.39 $2018573.93 $67.88
OCCT -97530HM OT SESSION BY OT ASST 273 314 2172.48 $118009.11 $54.32
PHY -97110 PT SESSION BY LICENSED PT 3667 4937 30666.17 $2081619.74 $67.88
PHY -97110HM PT SESSION BY PT ASST 302 332 2613.65 $141973.53 $54.32
SCONLY-SCONLY SERVICE COORDINATION ONLY 160 165 540.02 $540.02 $1.00
SENS -FM FM RECEIVER HEARING AID 5 5 5.00 $8250.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 40 44 60.00 $30000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 25 26 16.56 $712.04 $43.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 2.00 $228.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 13 15 42.00 $9959.04 $237.12
SENS -V5264 EARMOLD 99 108 160.85 $3011.13 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 2 13.14 $657.14 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 92 122 488.20 $24410.01 $50.00
SIC -SIC SPECIAL INSTRUCTION CONSULTATION 2 2 11.43 $571.43 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7392 9802 65425.16 $4441059.83 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 20 22 163.43 $8877.44 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 560 621 4929.08 $65063.86 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 21 25 121.35 $12135.25 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 4587 7650 741839.84 $370919.87 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 65.71 $3285.72 $50.00
VISN -T1024HN *EI VISION SERVICES, INDIVIDUAL 1 1 2.50 $125.00 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 122 170 948.25 $47412.43 $50.00
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Subtotal (Total Children Is Unduplicated) 13868 50117 976601.79 $14578267.57 $14.93
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Total 59854 988019.66 $15187144.42 $15.37
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Number of Children (Unduplicated) With at Least One Authorization 14363