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: 01-01-12 and 03-31-12 Date of Report: 05-15-12 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 5 5 5.000000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 13.044444 $482.6400 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 5 6 15.775397 $583.6900 $37.0000
TCON -TCON TRANSITION CONFERENCE 1 1 1.000000 $0.0000 $0.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 13 14 34.819841 $1066.3300 $30.6200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 68 79 81.819048 $3968.2300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 2 3 3.022222 $118.1100 $39.0800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 45 46 46.000000 $545.5600 $11.8600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 5 7 7.000000 $106.7500 $15.2500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 50 53 53.011111 $438.9300 $8.2800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $26.0600 $26.0600
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 52 56 58.044444 $602.5000 $10.3800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 51 54 56.044444 $1181.4200 $21.0800
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 11 11 10.055556 $520.4800 $51.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 38 39 41.033333 $1115.7000 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 264 285 272.180956 $16330.8800 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 32 34 46.725397 $2102.6400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 72 75 87.683333 $10083.5800 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 3 3 8.304761 $1038.0900 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 32 32 71.900000 $8987.5000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 36 45 29.688891 $1484.4600 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 323 344 650.428571 $32521.4300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 3 4 5.000000 $375.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 44 44 83.000000 $6225.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 8 8 14.500000 $1087.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 4 4 7.500000 $562.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 29 31 55.785714 $4183.9300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 61 63 98.176983 $5448.8100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 314 314 615.000000 $46125.0000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 81 81 150.500000 $11287.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 42 42 84.000000 $6300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 351 352 505.991652 $28082.4500 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 287 305 599.050000 $44928.7500 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 5 5 5.000000 $250.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 25 27 28.227780 $1369.0600 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 456 518 536.978573 $26043.4700 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 18 20 12.244445 $593.8600 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 441 506 491.900796 $23857.1900 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 60 66 58.211113 $2910.5700 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 628 698 683.811912 $33164.9100 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 4 4 8.714286 $871.4300 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 6 6 13.285714 $664.2900 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 2666 4267 5582.821035 $325568.5100 $58.3200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 108 118 239.194445 $358791.7500 $1500.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 2.533333 $174.4400 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 104 126 329.263491 $16463.1600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 845 1397 3622.706147 $181135.9100 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 39 42 38.762897 $969.0700 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2010 2589 8653.582525 $432679.0700 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 128 150 234.488884 $5862.2100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 794 953 2640.282527 $132014.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 42 50 89.130555 $2228.2600 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 953 1164 4094.336870 $204716.6900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 54 63 144.193251 $3604.8200 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2542 3123 7384.802959 $369240.1900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 128 142 190.978568 $4774.4500 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 14 39.474605 $2894.2800 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 6 7 912.142856 $11401.7900 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 4 4 24.333334 $608.3400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 331 416 3592.790473 $89819.7400 $25.0000
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 1 1 4.400000 $220.0000 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 12 12 208.214284 $10410.7300 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 11 13 43.690476 $2184.5200 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 12 12 55.496826 $1387.4200 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 6542 8830 63752.356815 $3187617.2500 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 2 4 19.500000 $975.0000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 77 102 441.995238 $22099.7400 $50.0000
INTR -INTR INTERPRETER 251 375 2269.852306 $113492.5900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1385 1881 11564.398419 $784991.3000 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 50 57 348.204763 $18914.4800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1980 2716 15807.760724 $1073030.7200 $67.8800
PHY -97110HM PT SESSION BY PT ASST 77 81 504.072617 $27381.2300 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 673 757 988.794438 $988.7900 $1.0000
SENS -FM FM RECEIVER HEARING AID 2 2 3.000000 $4950.0000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 10 11 18.600000 $9300.0000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 10 9.782496 $635.8600 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 9 9 14.639878 $3337.9000 $228.0000
SENS -V5264 EARMOLD 63 79 173.650790 $3125.7100 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 13.000000 $650.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 109 139 406.615872 $20330.8100 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2575 3462 21303.725825 $1446096.4400 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 5 39.571429 $2149.5200 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 62 65 486.359522 $6419.9500 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 8 8 39.161905 $3916.1800 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 5496 9976 2588646.991289 $1294323.5000 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 10 11 50.400000 $2520.0100 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 74 102 492.233332 $24611.6600 $50.0000
----------------------------------------------------------------------------
Subtotal (Total Children Is Unduplicated) 9994 39083 2739940.466964 $9883553.5600 $3.6100
-------------------------------------------------------------------------------------------------------------------------------------
Total 43364 2745558.107840 $10210188.4100 $3.7200
-------------------------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Authorization 10200