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: 01/01/10 and 03/31/10 Date of Report: 05-17-10 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 0.25 $9.25 $37.00
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 3 3 9.59 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 5 5 46.57 $1723.14 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 5 5 16.86 $623.71 $37.00
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Subtotal (Total Children Is Unduplicated) 14 14 73.27 $2356.10 $32.16
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 123 149 157.00 $7614.50 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 2 3 3.00 $108.21 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 103 103 96.23 $1022.00 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 11 15 12.29 $200.31 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 111 119 104.43 $922.15 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 3 3 2.03 $55.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 117 124 109.97 $1187.64 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 115 122 107.33 $2338.79 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 14 15 13.32 $724.46 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 87 87 80.42 $2274.33 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 13 15 12.32 $391.97 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 3 3 2.87 $61.18 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 440 479 486.76 $29205.74 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 81 83 89.70 $4197.96 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 292 301 342.70 $40987.48 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 8 8 9.36 $1169.64 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 32 32 54.14 $6767.85 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 62 66 89.53 $4476.59 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 380 402 773.64 $38682.15 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 64 67 119.50 $8962.50 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 12 12 23.00 $1725.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 26.30 $1972.50 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 58 59 108.80 $8160.00 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 55 59 108.86 $6041.57 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 34 34 68.00 $3774.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 772 842 1589.78 $119233.22 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 224 230 432.36 $32426.78 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 217 226 430.00 $32250.00 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 712 778 1467.24 $81431.98 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 433 498 904.29 $67821.43 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 5 5 6.00 $436.68 $72.78
NURS -NURS NURSING ASSESSMENT 1 1 6.00 $300.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 12 12 14.95 $747.62 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 222 284 285.43 $13843.29 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1302 1484 1624.02 $78765.11 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 224 296 315.47 $15300.13 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 951 1078 1133.13 $54956.69 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 45 48 49.00 $2450.00 $50.00
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.00 $15.00 $15.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2711 3197 3463.27 $167968.70 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 5.86 $585.71 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 6 6 6.00 $300.00 $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) 6221 11363 14738.31 $842001.44 $57.13
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 185 199 356.00 $534000.00 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 3 11.57 $796.81 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 9 10 37.43 $2577.33 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 279 331 780.54 $39027.15 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1054 1746 3098.49 $154924.72 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 44 44 54.34 $1358.52 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2510 2990 5554.73 $277736.45 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 162 177 358.47 $8961.76 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 1129 1417 2234.34 $111716.98 $50.00
CONOP -CONOP CONSULT, OT, PHONE 49 57 89.59 $2239.77 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 951 1164 2030.32 $101515.80 $50.00
CONPP -CONPP CONSULT, PT, PHONE 58 65 100.62 $2515.62 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2836 3408 5748.45 $287422.27 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 225 243 458.92 $11472.93 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 18 19 135.13 $9921.49 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 9 9 359.43 $4492.86 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 16 19 175.37 $4384.28 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 522 657 5368.90 $134222.47 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 8 9 534.43 $26721.43 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 13 14 12.79 $639.53 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 58 66 558.30 $27914.97 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 20 22 164.97 $4124.29 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7954 10242 76294.73 $3814736.41 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 33 39 88.43 $4421.45 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 109 133 679.77 $33988.33 $50.00
INTR -INTR INTERPRETER 262 335 1998.29 $99914.63 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 3380 4607 29791.71 $2022261.26 $67.88
OCCT -97530HM OT SESSION BY OT ASST 203 225 1725.94 $93752.81 $54.32
PHY -97110 PT SESSION BY LICENSED PT 3759 5244 31659.56 $2149051.03 $67.88
PHY -97110HM PT SESSION BY PT ASST 229 266 2210.50 $120074.34 $54.32
RSPT -RSPT RESPITE 1 2 2.00 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 956 1083 1128.63 $1128.63 $1.00
SENS -FM FM RECEIVER HEARING AID 7 7 9.00 $14850.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 61 62 84.00 $42000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 27 29 30.10 $1956.45 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.00 $114.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 22 26 44.80 $10622.98 $237.12
SENS -V5264 EARMOLD 160 195 303.12 $5674.40 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 8 10 39.39 $1969.53 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 144 185 527.98 $26399.08 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8033 10914 69241.64 $4700122.68 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 17 17 110.00 $5974.96 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 417 466 4100.88 $54131.67 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 8 8 47.71 $4770.96 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 5858 9594 1408138.63 $704069.39 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 4 5 15.66 $783.10 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 104 129 708.77 $35438.27 $50.00
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Subtotal (Total Children Is Unduplicated) 15887 56493 1657205.36 $15696893.70 $9.47
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Total 67870 1672016.94 $16541251.25 $9.89
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Number of Children (Unduplicated) With at Least One Authorization 16478