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: 04/01/10 and 06/30/10 Date of Report: 08-17-10 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
IFSP -IFSP INDIVIDUALIZED FAMILY SUPPORT PLAN 6 6 7.14 $0.00 $0.00
SCTT -SCTT SERVICE COORDINATOR TRAVEL 6 6 24.56 $908.67 $37.00
TCM -T1017TL TARGETED CASE MANAGEMENT 5 5 11.35 $420.04 $37.00
TCON -TCON TRANSITION CONFERENCE 3 3 3.00 $0.00 $0.00
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Subtotal (Total Children Is Unduplicated) 19 20 46.05 $1328.71 $28.85
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 143 161 171.00 $8293.50 $48.50
AUD -92626 EVAL OF AUD REHAB STATUS 16 16 18.62 $671.70 $36.07
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 114 117 115.10 $1222.36 $10.62
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 10 12 11.09 $180.84 $16.30
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 122 127 121.64 $1074.07 $8.83
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.00 $27.10 $27.10
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 126 133 133.85 $1445.57 $10.80
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 122 130 124.72 $2717.58 $21.79
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 13 14 17.80 $968.14 $54.38
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 87 88 87.07 $2462.25 $28.28
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 12 14 17.81 $566.50 $31.81
AUDE -92682 CONDITIONED PLAY AUDIOMETRY 1 1 1.00 $21.34 $21.34
AUDE -AUDE UNSPECIFIED AUDE SERVICES 447 475 503.39 $30203.40 $60.00
AUDE -V5010 ASSESSMENT FOR HEARING AID 74 76 83.33 $3900.04 $46.80
AUDE -V5090 DISPENSING FEE PER HEARING AID 338 348 395.60 $47313.76 $119.60
BEHV -BEHV BEHAVIORAL ASSESSMENT 6 6 39.00 $4875.01 $125.00
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 35 38 50.58 $6322.63 $125.00
EVAL -EVAL DEVELOPMENTAL EVALUATION 63 66 98.00 $4899.96 $50.00
EXIT -EXIT TRANSITION ASSESSMENT 495 526 943.71 $47185.72 $50.00
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 65 66 128.00 $9600.00 $75.00
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 6 6 11.00 $825.00 $75.00
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 6 6 9.00 $675.00 $75.00
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 45 45 86.50 $6487.50 $75.00
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 65 65 109.64 $6085.18 $55.50
IPDEI -IPDEI_NM INITIAL PSYCH & DEV EVAL BY NON-MED 17 17 34.00 $1887.00 $55.50
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 744 758 1487.79 $111583.93 $75.00
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 215 217 415.00 $31125.00 $75.00
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 210 213 416.50 $31237.50 $75.00
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 613 620 1212.85 $67313.31 $55.50
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 407 434 839.50 $62962.50 $75.00
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 4 4 5.00 $363.90 $72.78
MED -MED UNSPECIFIED MED OFFICE VISIT 1 1 2.00 $300.00 $150.00
NURS -NURS NURSING ASSESSMENT 1 1 1.40 $70.00 $50.00
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.00 $50.00 $50.00
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 12 12 16.03 $801.67 $50.00
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 220 285 285.00 $13822.50 $48.50
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1360 1544 1708.88 $82880.72 $48.50
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 218 293 319.11 $15476.85 $48.50
PSTH -97001 EVAL BY LICENSED PT, INITIAL 1014 1141 1215.24 $58939.14 $48.50
SCREEN-T1023 INTERDISCIPLINARY SCREENING 64 64 64.00 $3200.00 $50.00
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 2.00 $30.00 $15.00
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2860 3349 3698.95 $179399.13 $48.50
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 18.14 $1814.29 $100.00
VISF -VISF VISION EVALUATION FUNCTIONAL 4 4 4.00 $200.00 $50.00
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Subtotal (Total Children Is Unduplicated) 6570 11500 15024.86 $851481.58 $56.67
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 180 214 349.65 $524478.45 $1500.00
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 5 15.30 $1053.53 $68.86
AUD -92633 AUD REHAB POSTLING HEARING LOSS 5 5 23.18 $1595.91 $68.86
AUD -HA_FUP AUDIOLOGY SERVICES 267 313 817.56 $40877.86 $50.00
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1183 2188 3980.65 $199032.32 $50.00
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 56 63 64.96 $1623.99 $25.00
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2413 3036 5254.92 $262746.12 $50.00
CONIP -CONIP CONSULT, ITDS, PHONE 197 219 397.61 $9940.34 $25.00
CONOF -CONOF CONSULT, OT, FACE TO FACE 1137 1427 2439.16 $121957.76 $50.00
CONOP -CONOP CONSULT, OT, PHONE 48 55 89.23 $2230.82 $25.00
CONPF -CONPF CONSULT, PT, FACE TO FACE 980 1234 2240.34 $112016.82 $50.00
CONPP -CONPP CONSULT, PT, PHONE 69 74 156.87 $3921.64 $25.00
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2942 3648 5605.95 $280297.72 $50.00
CONSP -CONSP CONSULT, SLP, PHONE 236 257 434.83 $10870.63 $25.00
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 21 21 86.03 $6316.56 $73.42
ECE -ECE EARLY CHILDHOOD EDUCATION 8 9 547.71 $6846.43 $12.50
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 14 16 156.77 $3919.29 $25.00
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 532 676 5362.61 $134065.21 $25.00
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 11 12 495.71 $24785.71 $50.00
EIIF -COUN UNSPECIFIED COUNSELING 17 19 11.69 $584.44 $50.00
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 53 67 501.89 $25094.29 $50.00
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 15 16 131.46 $3286.55 $25.00
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8459 11063 82288.72 $4114436.14 $50.00
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 41 54 61.49 $3074.44 $50.00
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 97 116 644.84 $32241.90 $50.00
INTR -INTR INTERPRETER 284 374 2066.90 $103345.06 $50.00
OCCT -97530 OT SESSION BY LICENSED OT 3473 4691 30677.42 $2082383.34 $67.88
OCCT -97530HM OT SESSION BY OT ASST 220 255 1812.81 $98471.58 $54.32
PHY -97110 PT SESSION BY LICENSED PT 3920 5243 32846.29 $2229606.14 $67.88
PHY -97110HM PT SESSION BY PT ASST 218 246 2188.41 $118874.18 $54.32
RSPT -RSPT RESPITE 2 3 49.53 $0.00 $0.00
SCONLY-SCONLY SERVICE COORDINATION ONLY 1018 1132 1202.08 $1202.08 $1.00
SENS -FM FM RECEIVER HEARING AID 6 6 7.00 $11550.00 $1650.00
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 54 54 78.00 $39000.00 $500.00
SENS -HA_INS SENSORY AID INSURANCE PER EAR 27 30 35.94 $2335.93 $65.00
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 2.00 $228.00 $114.00
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 20 21 34.07 $8077.90 $237.12
SENS -V5264 EARMOLD 152 172 273.26 $5115.37 $18.72
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 7 8 34.38 $1718.81 $50.00
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 147 176 574.81 $28740.44 $50.00
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 8204 11028 72516.58 $4922425.47 $67.88
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 7 7 36.46 $1980.74 $54.32
SPL -92508 GROUP SPL SESSION PER CHILD 463 523 4414.40 $58270.14 $13.20
TRAN -TRAN FAMILY TRANSPORTATION 10 11 74.00 $7400.00 $100.00
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 6208 10381 1671722.52 $835861.24 $0.50
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 4 4 11.28 $564.17 $50.00
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 105 139 741.20 $37059.86 $50.00
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Subtotal (Total Children Is Unduplicated) 16676 59313 1933558.45 $16521505.28 $8.54
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Total 70833 1948629.36 $17374315.56 $8.92
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Number of Children (Unduplicated) With at Least One Authorization 17253