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
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 11 11 11.000000 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 2 2 13.044444 $482.6400 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 9 10 43.649207 $1615.0200 $37.0000
TCON -TCON TRANSITION CONFERENCE 4 4 4.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 24 27 71.693651 $2097.6600 $29.2600
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 97 113 116.185715 $5635.0100 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 5 5.022222 $196.2700 $39.0800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 82 85 85.000000 $1008.1000 $11.8600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 12 14 14.000000 $213.5000 $15.2500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 94 99 99.011111 $819.8100 $8.2800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $26.0600 $26.0600
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 97 104 106.044444 $1100.7400 $10.3800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.300000 $2.4300 $8.1000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 95 101 103.044444 $2172.1800 $21.0800
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $22.9600 $22.9600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 27 27 22.738889 $1176.9700 $51.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 66 68 70.033333 $1904.2100 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 399 435 395.372229 $23722.3700 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 57 60 74.369841 $3346.6400 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 124 129 147.753729 $16991.6900 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 4 4 9.304761 $1163.0900 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 52 55 106.042857 $13255.3600 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 53 68 39.313492 $1965.6800 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 469 496 931.428571 $46571.4300 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 6 8 12.000000 $900.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 58 58 111.000000 $8325.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 9 9 15.500000 $1162.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 5 5 9.500000 $712.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 42 45 82.785714 $6208.9300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 85 87 137.207538 $7615.0000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 485 485 952.500000 $71437.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 106 106 195.500000 $14662.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 68 68 134.000000 $10050.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 527 528 744.547197 $41322.2200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 430 457 910.835714 $68312.6900 $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 41 43 40.878573 $1982.6200 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 712 812 819.017463 $39722.3600 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 36 38 44.335716 $2150.2900 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 628 734 700.634923 $33980.8000 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 83 90 80.183336 $4009.1800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 4 5.088889 $76.3300 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 1108 1262 1253.584930 $60798.9100 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 4 4 8.714286 $871.4300 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 8 8 18.285714 $914.2900 $50.0000
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Subtotal (Total Children Is Unduplicated) 4104 6723 8609.065631 $496809.5400 $57.7100
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 186 209 413.797620 $620696.5500 $1500.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 2.533333 $174.4400 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 174 215 540.338200 $27016.8900 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1350 2299 6035.291748 $301765.5500 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 56 60 53.288493 $1332.2100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2951 3787 13454.810284 $672740.3900 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 162 192 321.383723 $8034.5800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1276 1559 4519.657918 $225982.8400 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 69 80 132.336507 $3308.4100 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1363 1693 6541.027731 $327051.1700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 64 74 164.676584 $4116.9100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3847 4751 11605.753333 $580287.6000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 173 191 308.235708 $7705.8700 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 12 16 44.807938 $3285.3200 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 7 8 1172.142856 $14651.7900 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 5 5 28.333334 $708.3400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 423 538 4630.357140 $115758.9000 $25.0000
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 2 2 7.866667 $393.3400 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 18 19 404.785712 $20239.3000 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 2 1.011111 $50.5600 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 27 32 107.709524 $5385.4700 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 18 18 100.234922 $2505.8700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8856 11972 86546.516783 $4327324.9700 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 3 6 22.533333 $1126.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 116 152 695.711906 $34785.5800 $50.0000
INTR -INTR INTERPRETER 281 412 2430.742782 $121537.1100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2178 2974 18484.520652 $1254729.2200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 81 90 583.635715 $31703.0900 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 2899 4031 23760.460350 $1612859.8400 $67.8800
PHY -97110HM PT SESSION BY PT ASST 103 109 666.291662 $36192.9700 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 867 976 1272.049194 $1272.0500 $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 34 37 57.282040 $28641.0500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 15 15 16.281126 $1058.2700 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 2 2 2.000000 $228.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 16 17 22.206012 $5062.9900 $228.0000
SENS -V5264 EARMOLD 116 145 257.927273 $4642.6800 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 13.000000 $650.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 147 187 530.165870 $26508.3000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4490 6080 38501.729682 $2613496.7100 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 8 9 61.128572 $3320.5100 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 124 133 974.740475 $12866.5800 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 8 8 39.161905 $3916.1800 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 7825 14329 3889637.850814 $1944818.9400 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 12 13 58.757143 $2937.8600 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 93 131 627.809521 $31390.4600 $50.0000
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Subtotal (Total Children Is Unduplicated) 14386 57587 4115859.883196 $15055812.2900 $3.6600
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Total 64337 4124540.642478 $15554719.4900 $3.7700
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Number of Children (Unduplicated) With at Least One Authorization 14713