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: 07/01/09 and 09/30/09 Date of Report: 11-16-09 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 1 1 2.00 $74.00 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 20 21 8.09 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 7 8 66.42 $2457.68 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 9 9 24.92 $922.18 $37.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 35 39 101.44 $3453.86 $34.05
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 73 91 106.14 $5147.93 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 7 7 7.00 $252.49 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 99 99 100.00 $1062.00 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 10 15 10.73 $174.86 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 117 126 115.93 $1023.64 $8.83
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 120 129 119.87 $1294.56 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 118 125 117.19 $2553.66 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 15 15 12.03 $654.37 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 49 50 49.02 $1386.35 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 9 12 8.05 $256.06 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 2 2 1.02 $21.81 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 476 506 528.31 $31698.46 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 78 83 92.13 $4311.77 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 327 339 406.17 $48578.12 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 27 28 62.86 $7857.15 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 40 41 48.71 $6089.29 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 96 102 163.61 $8180.31 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 314 339 666.21 $33310.71 $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 2 2 3.00 $225.00 $75.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 31 31 46.50 $3487.50 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 11 11 18.00 $1350.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 5.87 $440.00 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 26 28 36.87 $2765.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 67 70 112.85 $6263.31 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 26 26 51.50 $2858.25 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 636 636 1002.27 $75170.01 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 154 155 276.36 $20726.78 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 166 166 265.71 $19928.57 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 558 559 885.63 $49152.65 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 407 446 642.36 $48176.79 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 2 2 2.00 $145.56 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 2 2 2.00 $300.00 $150.00
NURS -NURS NURSING ASSESSMENT 4 4 12.00 $600.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 6 7 7.14 $357.15 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 205 257 292.02 $14163.12 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1347 1554 1664.04 $80705.77 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 220 269 282.04 $13678.73 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 995 1144 1261.40 $61177.74 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 35 37 37.00 $1850.00 $50.00
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.00 $15.00 $15.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2765 3247 3624.33 $175780.17 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 4 4 30.35 $3035.25 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 9 9 10.50 $525.00 $50.00
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 3.00 $145.50 $48.50
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 6050 10789 13196.72 $737056.40 $55.85
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 191 232 357.00 $535500.00 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 4 30.37 $2091.60 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 8 8 27.36 $1883.82 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 245 290 778.83 $38941.28 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1072 1973 3495.01 $174750.75 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 59 59 46.38 $1159.56 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2723 3325 6413.03 $320651.42 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 116 133 245.37 $6134.36 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 1236 1497 2384.75 $119237.39 $50.00
CONOP -CONOP CONSULT, OT, PHONE 43 51 74.44 $1861.05 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 1016 1240 2182.12 $109106.20 $50.00
CONPP -CONPP CONSULT, PT, PHONE 47 49 113.39 $2834.79 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2900 3494 6110.30 $305514.87 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 181 199 353.10 $8827.58 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 32 34 443.00 $32525.06 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 22 23 1764.29 $22053.57 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 6 6 17.35 $433.69 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 572 716 6070.55 $151763.69 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 15 17 421.86 $21092.85 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 6 6 14.69 $734.37 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 45 48 339.97 $16998.70 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 9 9 75.43 $1885.72 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7708 10016 74343.38 $3717168.92 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 35 39 65.13 $3256.25 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 99 144 860.95 $43047.71 $50.00
INTR -INTR INTERPRETER 210 260 1726.13 $86306.56 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 3585 4865 31935.61 $2167789.12 $67.88
OCCT -97530HM OT SESSION BY OT ASST 194 218 1802.36 $97904.13 $54.32
PHY -97110 PT SESSION BY LICENSED PT 3874 5347 33340.83 $2263175.37 $67.88
PHY -97110HM PT SESSION BY PT ASST 195 219 1651.32 $89699.95 $54.32
RSPT -RSPT RESPITE 2 2 41.60 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 854 935 996.77 $996.77 $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 59 62 84.22 $42111.10 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 24 24 21.60 $1403.84 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 2.00 $228.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 29 30 49.20 $11666.30 $237.12
SENS -V5264 EARMOLD 147 177 268.37 $5023.91 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 7 7 16.39 $819.45 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 135 164 687.78 $34389.07 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8431 11352 73622.00 $4997461.65 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 12 12 74.29 $4035.21 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 449 513 3875.19 $51152.54 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 9 10 111.72 $11172.39 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 5755 9414 1376699.30 $688349.56 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 3 3 25.60 $1280.00 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 115 168 895.03 $44751.46 $50.00
--------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 16012 57405 1634965.36 $16255671.54 $9.94
-----------------------------------------------------------------------------------------------------------------------------
Total 68233 1648263.53 $16996181.80 $10.31
-----------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 16437