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 3 3 26.873810 $994.3300 $37.0000
TCON -TCON TRANSITION CONFERENCE 3 3 3.000000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 19 53.918254 $1476.9700 $27.3900
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 73 86 87.185715 $4228.5100 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 19 20 20.000000 $237.2000 $11.8600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 19 20 20.000000 $165.6000 $8.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 19 20 20.000000 $207.6000 $10.3800
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.300000 $2.4300 $8.1000
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 19 20 20.000000 $421.6000 $21.0800
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 6 6 4.388889 $227.1700 $51.7600
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 18 18 18.000000 $489.4200 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 36 41 33.022223 $1981.3400 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 3.188889 $143.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 13 13 8.894445 $1022.8700 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 2 2 6.785714 $848.2100 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 15 15 19.000000 $2375.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 5 5 6.000000 $300.0000 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 404 430 807.428571 $40371.4300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 5 5 8.500000 $637.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 19 19 18.094443 $1004.2300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 71 71 139.500000 $10462.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 12 12 21.000000 $1575.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 9 9 16.000000 $1200.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 146 146 123.833318 $6872.6600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 82 87 181.785714 $13633.9400 $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 9 9 8.267461 $400.9800 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 94 105 108.077777 $5241.7700 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 5 5 3.138889 $152.2400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 59 64 64.173016 $3112.4000 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 12 13 11.105556 $555.2800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 1 1.000000 $15.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 178 189 198.396033 $9622.2200 $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) 1103 1460 2021.566653 $110455.8000 $54.6400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 57 66 67.472223 $101208.4500 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 82 96 256.644444 $12832.2200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1329 2274 5993.684605 $299685.1900 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 56 60 53.288493 $1332.2100 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2926 3752 13359.962668 $667998.0200 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 162 192 321.383723 $8034.5800 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1235 1502 4402.235299 $220111.7100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 66 77 128.919840 $3223.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1331 1647 6451.181700 $322558.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 64 74 164.676584 $4116.9100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3790 4680 11437.320798 $571865.9900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 170 188 303.769042 $7594.2100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 0.222222 $16.2900 $73.3100
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 260.000000 $3250.0000 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 3 3 20.466667 $511.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 67 79 659.119047 $16477.9800 $25.0000
EIIF -90801 PSYCHIATRIC DIAG INTERVIEW 2 2 7.866667 $393.3400 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 14 15 384.857141 $19242.8700 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 10 13 44.904763 $2245.2300 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 8 8 51.300000 $1282.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2110 2749 20817.022264 $1040850.9400 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 2 13.000000 $650.0000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 11 13 60.512699 $3025.6400 $50.0000
INTR -INTR INTERPRETER 281 411 2422.742782 $121137.1100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 342 422 2653.048821 $180088.9900 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 12 13 67.559525 $3669.8300 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 394 502 2723.876201 $184896.6800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 17 18 93.680950 $5088.7500 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 854 958 1256.460305 $1256.4600 $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 8 8 10.322222 $5161.1000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 10 9.260274 $601.9200 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 1.000000 $114.0000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 5 5 3.127778 $713.1400 $228.0000
SENS -V5264 EARMOLD 22 24 21.827778 $392.9000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 26 32 66.219046 $3310.9500 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 953 1186 7900.365480 $536276.6600 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 6.700000 $363.9400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 20 21 146.407143 $1932.5800 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 8 8 39.161905 $3916.1800 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 7775 14195 3867576.731767 $1933788.3800 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 2 2 16.000000 $800.0000 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 1 1 1.000000 $50.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 11322 35315 3950278.302866 $6297017.3400 $1.5900
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Total 36794 3952353.787773 $6408950.1200 $1.6200
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Number of Children (Unduplicated) With at Least One Authorization 11529