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 7 7 24.598413 $910.1400 $37.0000
TCON -TCON TRANSITION CONFERENCE 1 1 1.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 10 10 37.026984 $1333.0000 $36.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 76 80 98.142857 $4759.9300 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 15 15 14.285714 $169.4300 $11.8600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 14 14 13.285714 $110.0100 $8.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 15 15 14.285714 $148.2900 $10.3800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 1.022222 $8.2800 $8.1000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 15 15 14.285714 $301.1400 $21.0800
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 3 3 3.000000 $155.2800 $51.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 9 9 9.000000 $244.7100 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 43 45 44.066666 $2644.0000 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 7 7 7.000000 $315.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 22 23 28.000000 $3220.0000 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 7.571429 $946.4300 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 24 25 33.000000 $4125.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 12 12 13.000000 $650.0000 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 401 418 781.283333 $39064.1700 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 8 8 14.000000 $1050.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 4 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 15 16 29.000000 $1609.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 50 50 99.000000 $7425.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 13 13 25.000000 $1875.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 11 12 24.000000 $1800.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 124 125 239.000000 $13264.5000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 87 90 232.071428 $17405.3600 $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 17 18 19.000000 $921.5000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 106 110 111.823810 $5423.4500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 12 12 12.000000 $582.0000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 71 74 125.571429 $6090.2100 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 4 4 4.000000 $200.0000 $50.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 201 211 241.769048 $11725.7900 $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) 1158 1454 2301.465078 $129033.9600 $56.0700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 71 79 167.000000 $250500.0000 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 89 105 252.917462 $12645.8600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1180 2230 5291.791111 $264589.1700 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 47 51 54.420637 $1360.5200 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2614 3341 10475.310717 $523765.7300 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 130 156 291.339689 $7283.5100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1078 1321 3661.211928 $183060.7500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 52 60 107.001590 $2675.0500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1130 1429 4898.512308 $244925.8000 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 75 79 190.690876 $4767.2800 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3499 4267 9458.059218 $472903.1500 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 170 191 312.163494 $7804.0900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 4.022222 $294.9100 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 165.714286 $2071.4300 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 2 10.428572 $260.7100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 90 113 778.071433 $19451.8000 $25.0000
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 2 2 11.333333 $566.6700 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 11 13 289.466668 $14473.3400 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 13.142857 $657.1500 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 9 9 40.390476 $2019.5200 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 8 9 57.014286 $1425.3600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2132 2635 21104.830168 $1055242.2300 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 2 2 14.142857 $707.1500 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 8 10 49.946032 $2497.3000 $50.0000
INTR -INTR INTERPRETER 275 424 2521.197223 $126059.8900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 363 444 2995.256360 $203318.0300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 10 11 92.342857 $5016.0700 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 430 551 3077.459925 $208898.1400 $67.8800
PHY -97110HM PT SESSION BY PT ASST 17 20 129.495238 $7034.1900 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 912 1022 1151.114282 $1151.1100 $1.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 10 10 18.000000 $9000.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 10 9.252055 $601.3800 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 4 4 7.000000 $1596.0000 $228.0000
SENS -V5264 EARMOLD 19 19 29.022221 $522.4000 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 1.000000 $50.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 26 33 101.604764 $5080.2500 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1063 1318 8871.946835 $602227.9600 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 1.600000 $86.9100 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 18 20 148.709523 $1962.9700 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 2 2 1.285714 $128.5700 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 6495 10689 2703997.678643 $1351998.8100 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 1 1 1.571429 $78.5700 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 4 4 13.500000 $675.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 10870 30693 2780868.959289 $5601548.6900 $2.0100
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Total 32157 2783207.451351 $5731915.6600 $2.0600
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Number of Children (Unduplicated) With at Least One Authorization 11080