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: 07/01/10 and 09/30/10 Date of Report: 11-17-10 Page: 1
Child has a MEDICAID # Filter: Y
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 12 12 17.000000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 1 1 1.000000 $37.0000 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 2 3 5.000000 $185.0000 $37.0000
TCON -TCON TRANSITION CONFERENCE 3 3 3.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 16 19 26.000000 $222.0000 $8.5400
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 159 189 196.000000 $9506.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 10 10 19.138095 $777.7700 $40.6400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 52 52 52.000000 $641.1600 $12.3300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.000000 $15.8600 $15.8600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 53 53 53.000000 $456.3300 $8.6100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 56 56 56.000000 $604.8000 $10.8000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 53 53 53.022222 $1162.2500 $21.9200
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 1 1 1.000000 $53.8300 $53.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 52 52 52.000000 $1470.5600 $28.2800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $31.5200 $31.5200
AUDE -AUDE UNSPECIFIED AUDE SERVICES 283 302 323.496823 $19409.8000 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 56 60 72.171429 $3247.7100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 220 231 270.109522 $31062.5800 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 6 7 16.142856 $2017.8600 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 25 28 37.000000 $4625.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 38 38 45.871429 $2293.5700 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 282 300 555.221428 $27761.0700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 30 30 60.000000 $4500.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 15.500000 $1162.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 10 10 20.000000 $1500.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 28 28 56.000000 $4200.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 51 51 80.500000 $4467.7500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 425 426 838.566667 $62892.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 147 148 273.566666 $20517.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 151 151 297.500000 $22312.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 332 332 649.066667 $36023.2000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 393 413 807.550000 $60566.2500 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 2 2 3.000000 $218.3400 $72.7800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 12 12 19.900000 $995.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 109 142 145.428571 $7053.2900 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 788 915 1004.038095 $48695.8500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 128 160 174.287302 $8452.9400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 680 761 799.352382 $38768.6000 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 50 53 53.000000 $2650.0000 $50.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1538 1789 2020.935715 $98015.4000 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 26.285714 $2628.5800 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 1.000000 $50.0000 $50.0000
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 3.000000 $145.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 3904 6870 9153.651583 $531003.3500 $58.0100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 89 113 178.677779 $268016.8500 $1500.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 3 4.307241 $308.4500 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 8.477778 $607.1000 $71.6100
AUD -HA_FUP AUDIOLOGY SERVICES 124 151 384.726194 $19236.3100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 682 1280 2382.936510 $119146.8400 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 27 40 60.588098 $1514.7100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1415 1820 3356.604018 $167830.3900 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 130 146 165.012708 $4125.3400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 647 821 1317.880185 $65894.1400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 33 36 53.732544 $1343.3200 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 609 793 1415.747249 $70787.5000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 47 53 151.559924 $3789.0100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1803 2254 3384.834154 $169241.8300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 153 166 191.795639 $4794.9000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 17 18 71.166668 $5225.0700 $73.4200
ECE -ECE EARLY CHILDHOOD EDUCATION 12 12 1349.285713 $16866.0700 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 40.142857 $1003.5700 $25.0000
EIGF -T1027TTHM EI GROUP SESSION BY PARAPROF 1 1 1.000000 $12.5000 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 465 596 4240.914312 $106022.8500 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 7 7 279.090474 $13954.5300 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 19 22 12.777776 $638.8800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 20 24 156.076190 $7803.8300 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 8 10 66.638096 $1665.9600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5924 7836 58282.335488 $2914120.5000 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 30 41 39.572222 $1978.6100 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 73 94 423.680159 $21184.0400 $50.0000
INTR -INTR INTERPRETER 251 368 2010.792850 $100539.7000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2076 2843 17414.017035 $1182064.2800 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 142 162 1177.173810 $63944.1100 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 2588 3556 21622.792845 $1467756.1100 $67.8800
PHY -97110HM PT SESSION BY PT ASST 142 157 1215.983337 $66052.2300 $54.3200
RSPT -RSPT RESPITE 1 1 49.066667 $0.0000 $0.0000
SCONLY-SCONLY SERVICE COORDINATION ONLY 857 960 1105.183329 $1105.1800 $1.0000
SENS -FM FM RECEIVER HEARING AID 3 3 4.000000 $6600.0000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 23 25 36.000000 $18000.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 13 13 15.671233 $1018.6300 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 16 17 29.000000 $6612.0000 $228.0000
SENS -V5264 EARMOLD 73 83 127.076855 $2287.3700 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 5 5 24.371429 $1218.5700 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 101 130 409.634127 $20481.7300 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4333 5804 37351.302908 $2535407.9900 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 5.000000 $271.6000 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 250 276 2229.821417 $29433.6600 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 5 5 35.879365 $3587.9300 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 4228 7064 1270536.007013 $635267.9600 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 3 3 4.578571 $228.9300 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 93 126 579.451586 $28972.6000 $50.0000
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Subtotal (Total Children Is Unduplicated) 10609 37949 1434002.364353 $10157963.6300 $7.0800
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Total 44838 1443182.015936 $10689188.9800 $7.4100
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Number of Children (Unduplicated) With at Least One Authorization 10942