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: 01/01/09 and 03/31/09 Date of Report: 05-18-09 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 2 2 1.25 $46.25 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 94 97 84.26 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 32 35 55.07 $2037.65 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 7 8 36.64 $1355.79 $37.00
TCON -TCON TRANSITION CONFERENCE 5 5 5.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 117 147 182.23 $3439.68 $18.88
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 59 68 77.71 $3769.14 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 28 28 30.00 $1082.10 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 125 131 131.00 $1391.22 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 6 7 4.33 $70.54 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 133 140 136.62 $1206.33 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 135 145 142.04 $1534.08 $10.80
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.00 $8.44 $8.44
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 130 137 135.23 $2946.61 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 9 9 7.84 $426.58 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 111 117 117.00 $3308.76 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 4 4 2.52 $80.06 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 2 3 2.48 $52.88 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 400 428 450.74 $27044.18 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 53 60 63.33 $2964.00 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 314 323 467.19 $55876.37 $119.60
BEHV -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 12.86 $1607.14 $125.00
BEHV -BEHV BEHAVIORAL ASSESSMENT 17 17 22.66 $2832.75 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 52 57 124.14 $15517.86 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 184 204 320.19 $16009.48 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 162 172 273.46 $13673.22 $50.00
FANE -FANE FAMILY INTERVIEW BY COMMUNITY PROVI 7 7 7.00 $210.00 $30.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 3 3.00 $225.00 $75.00
IPDEF -IPDEF_NM F/U PSYCH & DEV EVAL BY NON-MED PRO 2 2 4.00 $222.00 $55.50
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 32 32 48.00 $3600.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 6.00 $450.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 8 8 13.00 $975.00 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 11 12 19.50 $1462.50 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 53 56 75.50 $4190.25 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 30 30 58.00 $3219.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 666 669 1100.05 $82503.75 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 132 132 208.00 $15600.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 204 204 348.50 $26137.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 616 618 1029.62 $57143.99 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 469 498 703.07 $52730.00 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 1 1 1.00 $72.78 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 1.00 $150.00 $150.00
NURS -NURS NURSING ASSESSMENT 8 8 26.00 $1300.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 4 4 4.00 $200.00 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 213 263 280.65 $13611.30 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1101 1258 1348.88 $65420.64 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 214 259 283.47 $13748.33 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 799 911 956.79 $46404.30 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 30 31 31.00 $1550.00 $50.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2503 2909 3218.33 $156089.18 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 5 5 21.73 $2173.33 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 7 7 8.50 $425.00 $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) 5521 9986 12328.94 $701291.18 $56.88
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 164 199 354.48 $531726.30 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.00 $68.86 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 241 278 654.14 $32706.88 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 957 1833 3327.40 $166370.25 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 48 49 42.04 $1050.95 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2593 3222 6252.18 $312608.94 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 138 151 277.33 $6933.36 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 1182 1483 2436.36 $121817.86 $50.00
CONOP -CONOP CONSULT, OT, PHONE 54 61 107.72 $2693.00 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 932 1184 2087.67 $104383.55 $50.00
CONPP -CONPP CONSULT, PT, PHONE 50 55 104.34 $2608.56 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2747 3366 5943.61 $297180.75 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 197 220 348.26 $8706.38 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 45 52 278.80 $20469.72 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 17 19 2388.29 $29853.57 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 8 8 17.63 $440.84 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 516 645 6812.67 $170316.64 $25.00
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 2.57 $128.57 $50.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 17 22 429.36 $21467.84 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 5 5 16.60 $830.08 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 42 50 400.29 $20014.27 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 14 14 131.90 $3297.61 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6914 8945 66597.07 $3329853.33 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 15 17 60.37 $3018.73 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 96 117 518.15 $25907.57 $50.00
INTR -INTR INTERPRETER 130 169 978.18 $48908.90 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 3429 4602 29791.46 $2022244.33 $67.88
OCCT -97530HM OT SESSION BY OT ASST 291 323 2297.61 $124805.99 $54.32
PHY -97110 PT SESSION BY LICENSED PT 3649 4908 30643.65 $2080090.65 $67.88
PHY -97110HM PT SESSION BY PT ASST 267 305 2014.20 $109411.20 $54.32
RSPT -RSPT RESPITE 2 2 70.93 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 659 703 927.25 $927.25 $1.00
SENS -FM FM RECEIVER HEARING AID 8 9 10.00 $16500.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 43 45 61.14 $30571.45 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 23 24 17.59 $1143.11 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 4.00 $456.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 20 21 38.00 $9010.56 $237.12
SENS -V5264 EARMOLD 119 143 223.80 $4189.61 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 1.00 $50.00 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 111 126 625.24 $31262.12 $50.00
SIC -SIC SPECIAL INSTRUCTION CONSULTATION 1 1 12.86 $642.86 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7696 10247 67307.49 $4568832.34 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 18 19 94.65 $5141.51 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 627 681 5310.54 $70099.15 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 17 18 92.41 $9240.93 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 5126 8524 855085.89 $427543.00 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 1 1 7.60 $380.00 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 105 135 783.74 $39187.25 $50.00
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Subtotal (Total Children Is Unduplicated) 14753 53006 1095989.47 $14815092.57 $13.52
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Total 63139 1108500.64 $15519823.43 $14.00
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Number of Children (Unduplicated) With at Least One Authorization 15179