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: 01/01/08 and 12/31/08 Date of Report: 02-16-09 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 3 3 4.35 $161.04 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 1596 1684 2330.75 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 93 108 180.71 $6686.43 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 52 53 102.69 $3799.60 $37.00
TCON -TCON TRANSITION CONFERENCE 18 18 18.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 1688 1866 2636.51 $10647.06 $4.04
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 153 203 242.58 $11765.15 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 38 39 61.25 $2209.14 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 312 347 503.00 $5341.86 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 6 6.00 $97.80 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 280 305 305.00 $2693.15 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 5 5 5.00 $135.50 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 284 310 310.31 $3351.36 $10.80
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.00 $8.44 $8.44
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 273 300 299.31 $6521.99 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 10 12 12.00 $652.56 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 250 273 274.00 $7748.72 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 2 2 2.00 $63.62 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 2 2 2.00 $42.68 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 764 922 1400.80 $84047.84 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 100 135 147.41 $6898.84 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 624 672 857.38 $102542.23 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 3 3 13.29 $1660.71 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 24 24 52.84 $6605.35 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 144 152 548.04 $68505.49 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 1030 1328 1728.86 $86443.23 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 275 307 411.07 $20553.58 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 72 72 86.00 $2580.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 19 20 25.50 $1912.50 $75.00
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 3 3 4.00 $222.00 $55.50
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 98 101 135.48 $10161.20 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 14 14 17.51 $1312.92 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 21 21 31.23 $2342.09 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 90 92 118.57 $8892.86 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 210 223 287.72 $15968.59 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 94 94 115.50 $6410.25 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 1841 1859 2661.64 $199623.23 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 437 443 612.43 $45932.15 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 530 534 778.60 $58395.36 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 1680 1711 2509.00 $139249.25 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 1883 2099 2937.20 $220290.37 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 9 10 12.00 $873.36 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 6 6 6.00 $900.00 $150.00
NURS -NURS NURSING ASSESSMENT 4 4 2.80 $140.00 $50.00
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 3 3 2.27 $113.34 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 10 11 11.00 $550.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 493 711 883.05 $42827.77 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 2285 2725 3181.05 $154281.11 $48.50
PDEO -T1024 *PSY-DEV EVAL OUTPATIENT, INITIAL 8 8 14.77 $2215.49 $150.00
PDFO -T1024HTTS *PSY-DEV EVAL OUTPATIENT, FOLLOW-UP 2 2 0.68 $102.11 $150.00
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 498 754 849.40 $41195.75 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1670 1992 2281.89 $110671.78 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 101 101 106.73 $5336.67 $50.00
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.00 $15.00 $15.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 4674 6086 7223.66 $350347.51 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 7 7 16.47 $1646.67 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 23 28 67.20 $3359.77 $50.00
WHEELO-97003TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 5.00 $242.50 $48.50
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 1.00 $48.50 $48.50
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Subtotal (Total Children Is Unduplicated) 11993 25085 32169.49 $1846049.28 $57.39
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 481 643 995.79 $1493690.40 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 6 10.93 $752.87 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 6 9.01 $620.50 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 463 578 1858.68 $92934.11 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1937 4385 8319.85 $415992.43 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 119 138 266.91 $6672.71 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 4076 6336 20335.71 $1016785.68 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 353 400 1630.21 $40755.25 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 2041 3183 8452.01 $422600.50 $50.00
CONOP -CONOP CONSULT, OT, PHONE 131 150 436.94 $10923.51 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 1440 2292 6243.49 $312174.35 $50.00
CONPP -CONPP CONSULT, PT, PHONE 89 115 392.39 $9809.76 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4393 6485 18950.74 $947536.85 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 496 576 1997.88 $49947.04 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 122 133 1008.06 $74011.63 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 50 62 14016.71 $175208.93 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 21 24 91.37 $2284.16 $25.00
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 131 132 2260.62 $56515.39 $25.00
EIGF -T1027TTHM EI GROUP SESSION BY PARAPROF 2 2 15.00 $187.50 $12.50
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 954 1411 19293.84 $482345.97 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 23.86 $1192.86 $50.00
EIIF -90812 INDIVIDUAL PSYCHOTHERAPY, 45-50 MIN 1 1 3.77 $188.34 $50.00
EIIF -90846 FAMILY PSYCHOTHERAPY W/O PATIENT 1 1 7.71 $385.72 $50.00
EIIF -90847 FAMILY PSYCHOTHERAPY WITH PATIENT 1 1 8.29 $414.29 $50.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 36 44 1234.09 $61704.30 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 15 16 116.23 $5811.59 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 106 144 2240.57 $112028.60 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 1782 1831 16029.61 $801480.36 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 28 32 457.70 $11442.62 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 10303 17059 251620.49 $12581024.32 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 2 3 41.82 $2090.95 $50.00
HERN -T1024HN *EI HEARING SERVICES AFTER SHINE 22 22 246.56 $12328.09 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 110 181 1671.99 $83599.47 $50.00
INTR -INTR INTERPRETER 222 331 3138.14 $156906.76 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 5875 10812 121545.55 $8250512.21 $67.88
OCCT -97530HM OT SESSION BY OT ASST 633 769 9997.32 $543054.15 $54.32
PHY -97110 PT SESSION BY LICENSED PT 5826 10995 126174.22 $8564706.29 $67.88
PHY -97110HM PT SESSION BY PT ASST 658 778 10722.22 $582430.72 $54.32
RSPT -RSPT RESPITE 1 1 103.47 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 483 519 1706.84 $1706.84 $1.00
SENS -FM FM RECEIVER HEARING AID 17 17 21.43 $35357.19 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 81 94 134.72 $67361.10 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 35 44 43.88 $2852.40 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 6 6 8.00 $912.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 35 40 124.54 $29531.59 $237.12
SENS -V5264 EARMOLD 184 252 535.53 $10025.21 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 2 26.43 $1321.43 $50.00
SHIN -T1024HN *INITIAL SHINE SERVICES, INDIVIDUAL 8 8 56.59 $2829.29 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 158 243 1833.89 $91694.70 $50.00
SIC -SIC SPECIAL INSTRUCTION CONSULTATION 4 4 42.14 $2107.14 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 12556 22192 257856.23 $17503281.13 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 94 102 920.67 $50010.85 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 1234 1487 22595.64 $298262.39 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 51 80 376.67 $37667.17 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 7705 16367 2400890.49 $1200445.19 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 3 3 153.71 $7685.71 $50.00
VISN -T1024HN *EI VISION SERVICES, INDIVIDUAL 41 41 386.04 $19302.04 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 177 320 3366.12 $168306.07 $50.00
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Subtotal (Total Children Is Unduplicated) 22729 111900 3343049.31 $56913710.54 $17.02
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Total 138851 3377855.31 $58770406.89 $17.40
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Number of Children (Unduplicated) With at Least One Authorization 23957