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
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 2 2 3.428571 $126.8600 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 4 5 12.271429 $454.0400 $37.0000
TCON -TCON TRANSITION CONFERENCE 4 4 4.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 20 23 36.700000 $580.9000 $15.8300
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 189 225 234.000000 $11349.0000 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 13 13 23.138095 $940.3300 $40.6400
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 72 72 72.000000 $887.7600 $12.3300
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 14 18 17.377778 $275.6100 $15.8600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 88 93 91.066667 $784.0800 $8.6100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 96 101 99.444445 $1074.0000 $10.8000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 89 94 92.466667 $2026.8700 $21.9200
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 12 12 12.000000 $645.9600 $53.8300
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 74 75 75.000000 $2121.0000 $28.2800
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 12 12 11.377778 $358.6300 $31.5200
AUDE -AUDE UNSPECIFIED AUDE SERVICES 419 450 470.533330 $28231.9800 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 93 100 122.915873 $5531.2100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 330 350 414.055553 $47616.3600 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 10 11 24.747618 $3093.4500 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 34 37 48.000000 $6000.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 44 44 66.239683 $3311.9800 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 469 498 908.578571 $45428.9300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 1.000000 $75.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 49 50 100.000000 $7500.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 17.500000 $1312.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 14 14 27.500000 $2062.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 42 43 86.000000 $6450.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 71 71 114.500000 $6354.7500 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 593 594 1168.066667 $87605.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 217 218 406.066666 $30455.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 199 199 392.500000 $29437.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 485 485 951.066667 $52784.2000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 529 559 1085.550000 $81416.2500 $75.0000
MED -99205 OUTPATIENT VISIT, NEW, 60 MINS 5 5 7.000000 $509.4600 $72.7800
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.000000 $100.0000 $50.0000
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 15 15 28.033333 $1401.6700 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 202 256 259.428571 $12582.2900 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 1310 1518 1649.943651 $80022.2700 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 217 278 314.978572 $15276.4700 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 996 1117 1173.019049 $56891.4300 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 69 72 72.000000 $3600.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 2645 3107 3585.660318 $173904.5500 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 4 4 27.419047 $2741.9100 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 2.000000 $100.0000 $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) 6103 10826 14258.174599 $812420.4000 $56.9800
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 185 227 389.706350 $584559.7500 $1500.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 4 4 5.307241 $380.0600 $71.6100
AUD -92633 AUD REHAB POSTLING HEARING LOSS 6 6 8.477778 $607.1000 $71.6100
AUD -HA_FUP AUDIOLOGY SERVICES 255 316 772.327781 $38616.3800 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1124 2120 3828.523813 $191426.2000 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 39 55 81.188099 $2029.7100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2162 2793 4970.205229 $248510.5400 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 193 219 257.417074 $6435.4600 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1071 1335 2253.767106 $112688.5700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 58 65 105.566672 $2639.1800 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 935 1222 2162.770276 $108138.7000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 74 85 255.483737 $6387.1100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2880 3648 5560.520279 $278026.1800 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 240 260 318.173669 $7954.3400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 21 22 98.066668 $7200.0600 $73.4200
ECE -ECE EARLY CHILDHOOD EDUCATION 15 15 1382.142856 $17276.7900 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 6 6 51.285714 $1282.1500 $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 629 807 5960.790517 $149019.7700 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 14 17 655.038093 $32751.9100 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 23 28 16.844442 $842.2100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 32 40 256.942858 $12847.1600 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 11 14 91.638095 $2290.9600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8370 11096 83051.735381 $4152592.1000 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 41 56 55.372222 $2768.6100 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 103 129 581.437298 $29071.9000 $50.0000
INTR -INTR INTERPRETER 268 393 2065.245232 $103262.3100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 3417 4686 29538.239250 $2005057.0100 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 231 265 2059.130957 $111852.0300 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 3874 5385 33129.698784 $2248845.2100 $67.8800
PHY -97110HM PT SESSION BY PT ASST 207 230 2008.611909 $109107.8300 $54.3200
RSPT -RSPT RESPITE 1 1 49.066667 $0.0000 $0.0000
SCONLY-SCONLY SERVICE COORDINATION ONLY 1115 1240 1389.653170 $1389.6500 $1.0000
SENS -FM FM RECEIVER HEARING AID 8 8 10.000000 $16500.0000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 63 68 110.088889 $55044.4500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 22 22 27.671233 $1798.6300 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 22 23 41.933333 $9560.7900 $228.0000
SENS -V5264 EARMOLD 151 182 274.487965 $4940.7700 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 9 11 51.657143 $2582.8600 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 148 187 613.600793 $30680.0600 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 7737 10533 69872.787375 $4742967.8500 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 29.214286 $1586.9200 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 441 506 4210.873801 $55583.5400 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 7 7 50.879365 $5087.9300 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 6118 10332 1990013.055364 $995006.4600 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 3 3 4.578571 $228.9300 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 113 150 752.735713 $37636.8100 $50.0000
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Subtotal (Total Children Is Unduplicated) 16214 58822 2249475.939048 $16535189.3800 $7.3500
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Total 69671 2263770.813647 $17348190.6700 $7.6600
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Number of Children (Unduplicated) With at Least One Authorization 16717