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: 10/01/08 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
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 379 383 378.24 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 24 26 33.57 $1242.15 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 12 12 15.21 $562.59 $37.00
TCON -TCON TRANSITION CONFERENCE 3 3 3.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 399 424 430.02 $1804.73 $4.20
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 65 75 80.86 $3921.57 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 33 33 46.49 $1676.80 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 102 103 103.00 $1093.86 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 4 5 5.00 $81.50 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 102 103 103.00 $909.49 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 3.00 $81.30 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 103 104 104.00 $1123.20 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 97 98 98.00 $2135.42 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 3 3 3.00 $163.14 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 89 90 90.00 $2545.20 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.00 $31.81 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 2 2 2.00 $42.68 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 333 369 390.74 $23444.14 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 62 70 70.37 $3293.16 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 285 295 359.36 $42979.07 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 3 3 13.29 $1660.71 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 11 11 14.70 $1837.50 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 67 69 150.47 $18809.15 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 252 281 387.65 $19382.39 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 116 129 201.54 $10076.79 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 6 6 6.00 $180.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 4 4.50 $337.50 $75.00
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 1 1 1.00 $55.50 $55.50
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 35 35 50.07 $3755.36 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 9.50 $712.50 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 10.50 $787.50 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 10 10 14.07 $1055.36 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 49 50 68.00 $3774.00 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 32 32 47.00 $2608.50 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 534 537 839.71 $62978.58 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 110 110 163.50 $12262.50 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 169 170 279.64 $20973.22 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 476 476 769.60 $42713.07 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 436 495 748.86 $56164.29 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 4 4 6.00 $436.68 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 1.00 $150.00 $150.00
NURS -NURS NURSING ASSESSMENT 4 4 2.80 $140.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 4 5 5.00 $250.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 217 252 274.51 $13313.87 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1057 1188 1314.93 $63774.16 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 203 250 267.52 $12974.79 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 804 889 943.73 $45770.84 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 32 32 31.73 $1586.67 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2316 2626 2928.18 $142016.68 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 5 5 12.07 $1206.67 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 9 9 15.57 $778.57 $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) 5218 9051 11043.45 $626094.17 $56.69
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 197 228 311.74 $467604.75 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 2 1.02 $70.40 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 0.86 $58.92 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 264 297 633.03 $31651.39 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 897 1781 3379.71 $168985.61 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 52 56 59.89 $1497.15 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2518 3068 6138.09 $306904.72 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 145 158 307.54 $7688.57 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 1188 1449 2549.31 $127465.34 $50.00
CONOP -CONOP CONSULT, OT, PHONE 61 69 114.75 $2868.80 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 859 1042 1944.71 $97235.63 $50.00
CONPP -CONPP CONSULT, PT, PHONE 62 70 140.29 $3507.18 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2634 3214 5749.28 $287463.83 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 197 222 364.46 $9111.60 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 60 63 232.94 $17102.26 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 19 19 2901.86 $36273.21 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 8 9 17.77 $444.17 $25.00
EIGF -T1024TTHN *EI GROUP SESSION BY PROF 1 1 52.57 $1314.29 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 550 656 6113.59 $152839.85 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 13.14 $657.15 $50.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 18 22 411.71 $20585.73 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 5 5 18.87 $943.34 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 47 51 542.14 $27107.21 $50.00
EIIF -T1024HN *EI INDIVIDUAL SESSION BY PROF 5 5 37.43 $1871.43 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 12 15 116.71 $2917.87 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6693 8601 66010.74 $3300536.79 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 2 2 2.68 $133.81 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 74 89 426.88 $21343.98 $50.00
INTR -INTR INTERPRETER 117 136 814.99 $40749.56 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 3513 4619 29989.53 $2035689.63 $67.88
OCCT -97530HM OT SESSION BY OT ASST 303 340 2066.27 $112239.65 $54.32
PHY -97110 PT SESSION BY LICENSED PT 3685 4835 31162.80 $2115331.11 $67.88
PHY -97110HM PT SESSION BY PT ASST 317 341 2117.99 $115049.44 $54.32
RSPT -RSPT RESPITE 1 1 49.07 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 461 485 787.35 $787.35 $1.00
SENS -FM FM RECEIVER HEARING AID 9 9 10.00 $16500.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 52 54 71.72 $35861.10 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 25 29 18.02 $1171.62 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 3 3 5.00 $570.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 19 21 78.14 $18529.24 $237.12
SENS -V5264 EARMOLD 118 134 201.99 $3781.31 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 2 7.57 $378.57 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 98 117 588.24 $29411.79 $50.00
SIC -SIC SPECIAL INSTRUCTION CONSULTATION 1 1 11.86 $592.86 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7637 10035 67684.56 $4594428.02 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 20 23 139.87 $7597.83 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 602 638 5091.09 $67202.43 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 17 20 83.57 $8357.13 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 4870 7991 795553.53 $397776.70 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 31.57 $1578.58 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 118 149 868.20 $43409.85 $50.00
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Subtotal (Total Children Is Unduplicated) 14527 51181 1036026.65 $14743178.65 $14.23
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Total 60656 1047500.12 $15371077.55 $14.67
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Number of Children (Unduplicated) With at Least One Authorization 14976