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: 10-01-11 and 12-31-11 Date of Report: 02-15-12 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 11.428571 $422.8600 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 17 17 50.552382 $1870.4500 $37.0000
TCON -TCON TRANSITION CONFERENCE 1 1 1.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 20 20 62.980953 $2293.3000 $36.4100
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 96 100 120.142857 $5826.9300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 2 3.044444 $118.9800 $39.0800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 102 103 101.571428 $1204.6400 $11.8600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 10 14 14.000000 $213.5000 $15.2500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 110 115 113.571428 $940.3700 $8.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 113 119 116.593650 $1210.2400 $10.3800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.022222 $8.2800 $8.1000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 112 118 115.593650 $2436.7100 $21.0800
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $22.9600 $22.9600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 24 24 24.000000 $1242.2400 $51.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 76 77 76.285714 $2074.2100 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 421 456 474.934915 $28496.0600 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 68 73 88.677777 $3990.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 142 149 173.122223 $19909.0600 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 13 13 45.928572 $5741.0800 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 71 75 130.309523 $16288.6900 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 55 70 77.818253 $3890.9000 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 464 488 915.283333 $45764.1700 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 45 45 86.000000 $6450.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 9.500000 $712.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 8.000000 $600.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 37 38 70.000000 $5250.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 85 92 160.651077 $8916.1400 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 392 392 767.000000 $57525.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 142 143 268.000000 $20100.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 83 84 166.500000 $12487.5000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 400 401 772.500000 $42873.7500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 450 494 1031.104761 $77332.8500 $75.0000
MED -MED UNSPECIFIED MED OFFICE VISIT 2 2 2.000000 $300.0000 $150.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 2 2 2.000000 $100.0000 $50.0000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 1.000000 $50.0000 $50.0000
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 7 7 7.000000 $350.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 78 84 91.285715 $4427.3600 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 772 894 944.357144 $45801.3300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 71 80 90.400000 $4384.4000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 713 810 927.142858 $44966.4400 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 33 35 35.000000 $1750.0000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 5 6.044444 $90.6700 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1301 1456 1658.376974 $80431.2800 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 3.000000 $300.0000 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 8 9 19.000000 $950.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 4348 7084 9720.762962 $555678.7200 $57.1600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 211 236 486.857143 $730285.8000 $1500.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 4 4 4.533333 $312.1600 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 187 237 537.838101 $26891.8900 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1196 2249 5324.795079 $266239.3700 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 48 52 57.287304 $1432.1900 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2644 3378 10567.132146 $528356.8100 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 131 157 292.439689 $7311.0100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1111 1363 3731.214310 $186560.8700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 54 62 110.184924 $2754.6400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1159 1463 4955.328181 $247766.5900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 76 80 191.724209 $4793.1200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3560 4339 9627.693741 $481384.8600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 175 196 319.513494 $7987.8400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 16 18 61.446031 $4505.2200 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 7 7 1409.571429 $17619.6400 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 3 3 15.142858 $378.5700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 488 588 5488.961898 $137224.2300 $25.0000
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 2 2 11.333333 $566.6700 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 16 24 355.966668 $17798.3400 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 2 2 13.676190 $683.8100 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 14 14 65.676190 $3283.8100 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 27 28 216.490476 $5412.2800 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8750 11305 87947.867420 $4397396.9000 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 4 4 23.780953 $1189.0500 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 108 127 768.242860 $38412.1800 $50.0000
INTR -INTR INTERPRETER 276 425 2532.625794 $126631.3200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2395 3118 21016.751621 $1426617.6800 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 108 114 815.254760 $44284.6700 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 3154 4186 26538.430292 $1801429.2200 $67.8800
PHY -97110HM PT SESSION BY PT ASST 97 109 738.626189 $40122.2100 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 929 1043 1171.780948 $1171.7800 $1.0000
SENS -FM FM RECEIVER HEARING AID 5 5 7.000000 $11550.0000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 41 43 64.022222 $32011.1000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 18 22 25.711721 $1671.2600 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 3 4 4.000000 $456.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 14 15 27.000000 $6156.0000 $228.0000
SENS -V5264 EARMOLD 123 144 203.333324 $3659.9800 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 2 2 11.285714 $564.2900 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 165 194 614.034923 $30701.7800 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 5032 6551 44329.998826 $3009121.8700 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 9 9 86.161904 $4680.3100 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 136 147 1164.716663 $15374.2700 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 2 2 1.285714 $128.5700 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 6549 10818 2721664.502454 $1360832.2300 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 12 14 65.054763 $3252.7300 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 102 126 625.037702 $31251.8900 $50.0000
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Subtotal (Total Children Is Unduplicated) 14670 53029 2954291.313494 $15068216.9600 $5.1000
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Total 60133 2964075.057409 $15626188.9900 $5.2700
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Number of Children (Unduplicated) With at Least One Authorization 14975