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: 10/01/09 and 12/31/09 Date of Report: 02-15-10 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 6 6 8.16 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 43.43 $1606.85 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 7 7 55.85 $2066.54 $37.00
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Subtotal (Total Children Is Unduplicated) 17 17 109.44 $3747.40 $34.24
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 96 103 110.71 $5369.64 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 2.00 $72.14 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 103 104 104.00 $1104.48 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 10 12 9.49 $154.67 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 120 125 119.58 $1055.87 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 2 2 2.00 $54.20 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 122 127 120.84 $1305.12 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 121 126 118.84 $2589.62 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 9 10 9.74 $529.90 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 96 97 96.53 $2729.96 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 8 10 7.98 $253.78 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 2 2 2.02 $43.15 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 432 468 496.35 $29781.21 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 75 77 107.63 $5037.09 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 288 299 334.45 $40000.10 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 15 16 21.00 $2625.00 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 37 37 52.71 $6589.29 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 75 77 109.74 $5486.75 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 340 362 712.21 $35610.72 $50.00
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 2 2 4.00 $300.00 $75.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 41 41 66.00 $4950.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 10 10 15.00 $1125.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 24.57 $1842.50 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 38 39 62.57 $4692.50 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 65 65 108.23 $6006.69 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 31 31 62.00 $3441.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 600 601 1077.50 $80812.50 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 240 241 439.79 $32983.93 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 130 130 235.89 $17691.79 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 514 517 926.35 $51412.29 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 396 416 714.36 $53576.79 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 5 5 7.00 $509.46 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 1.00 $150.00 $150.00
NURS -NURS NURSING ASSESSMENT 1 1 4.80 $240.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 3 3 8.57 $428.57 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 215 270 292.94 $14207.58 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1337 1522 1674.85 $81230.34 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 227 290 312.17 $15140.01 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1022 1145 1182.99 $57375.05 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 40 43 43.00 $2150.00 $50.00
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 4 4.00 $60.00 $15.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2827 3307 3510.60 $170264.24 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 5 5 23.55 $2355.25 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 6 6 7.00 $350.00 $50.00
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 3.00 $145.50 $48.50
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Subtotal (Total Children Is Unduplicated) 6157 10766 13349.56 $743833.67 $55.72
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 180 209 332.00 $498000.00 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 5 6 22.59 $1555.80 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 9 26.57 $1829.71 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 270 315 859.61 $42980.75 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1066 1800 3168.61 $158430.27 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 56 65 57.92 $1447.98 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2704 3236 6399.12 $319956.25 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 120 134 229.25 $5731.29 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 1173 1432 2321.78 $116089.09 $50.00
CONOP -CONOP CONSULT, OT, PHONE 44 49 70.84 $1770.97 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 990 1178 2063.93 $103196.31 $50.00
CONPP -CONPP CONSULT, PT, PHONE 43 48 83.18 $2079.60 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2869 3443 6205.37 $310268.29 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 187 202 421.07 $10526.65 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 24 25 239.29 $17568.70 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 19 19 776.43 $9705.35 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 12 12 115.63 $2890.72 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 516 614 6307.02 $157675.48 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 10 284.29 $14214.29 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 14 14 18.53 $926.27 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 52 57 526.59 $26329.32 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 17 17 155.14 $3878.58 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7844 9956 77811.02 $3890550.82 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 35 43 105.58 $5278.95 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 106 131 833.52 $41675.79 $50.00
INTR -INTR INTERPRETER 239 283 1838.70 $91935.21 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 3495 4698 31021.90 $2105766.77 $67.88
OCCT -97530HM OT SESSION BY OT ASST 196 225 2097.63 $113943.18 $54.32
PHY -97110 PT SESSION BY LICENSED PT 3902 5204 32746.12 $2222806.67 $67.88
PHY -97110HM PT SESSION BY PT ASST 234 265 2137.55 $116111.57 $54.32
RSPT -RSPT RESPITE 1 1 16.00 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 971 1080 1128.14 $1128.14 $1.00
SENS -FM FM RECEIVER HEARING AID 10 10 12.00 $19800.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 56 60 77.00 $38500.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 33 38 32.96 $2142.34 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 4 4 4.00 $456.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 30 30 53.13 $12598.97 $237.12
SENS -V5264 EARMOLD 159 182 290.06 $5429.86 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 10 10 35.31 $1765.52 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 148 180 587.50 $29375.06 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8344 11088 73138.04 $4964610.16 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 16 16 116.58 $6332.43 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 433 484 4257.72 $56201.85 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 7 7 124.71 $12471.43 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 5939 9633 1448683.29 $724341.55 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 4 5 13.53 $676.43 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 106 142 877.33 $43866.25 $50.00
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Subtotal (Total Children Is Unduplicated) 16207 56669 1708724.06 $16314816.59 $9.55
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Total 67452 1722183.06 $17062397.66 $9.91
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Number of Children (Unduplicated) With at Least One Authorization 16645