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: 04-01-12 and 06-30-12 Date of Report: 08-16-12 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 3 3 4.080953 $151.0000 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 7 9 23.168253 $857.2200 $37.0000
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Subtotal (Total Children Is Unduplicated) 10 12 27.249206 $1008.2200 $37.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 125 144 137.518260 $6669.6600 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 5.288889 $206.6900 $39.0800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 114 115 115.000000 $1363.9000 $11.8600
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 11 13 13.000000 $198.2500 $15.2500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 126 129 128.844444 $1066.8300 $8.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 128 131 131.655555 $1366.5800 $10.3800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 129 132 132.655555 $2796.3800 $21.0800
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 2 2 2.000000 $45.9200 $22.9600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 25 26 33.827779 $1750.9300 $51.7600
AUDE -92586 AUD EVOKED RESPONSE (SCREEN) 1 1 1.000000 $30.4900 $30.4900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 104 105 106.533333 $2896.6400 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 365 395 374.100800 $22446.0900 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 46 51 65.209524 $2934.4300 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 116 123 162.071896 $18638.2600 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 18 18 58.585715 $7323.2100 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 64 75 64.144448 $3207.2400 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 469 504 930.242856 $46512.1400 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 10 14.000000 $1050.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 65 66 125.566667 $9417.5000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 5 5 10.000000 $750.0000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 20 21 42.000000 $3150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 80 82 141.544444 $7855.7100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 379 379 742.511111 $55688.3300 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 83 83 143.550000 $10766.2500 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 19 19 38.000000 $2850.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 355 355 566.161101 $31421.8800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 243 287 560.066667 $42005.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 1.000000 $50.0000 $50.0000
NUTR -NUTR UNSPECIFIED NUTRITIONAL EVAL 1 1 1.000000 $50.0000 $50.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 32 32 33.454761 $1622.5500 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 628 712 730.115089 $35410.6300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 22 24 31.295239 $1517.8300 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 568 658 631.396841 $30622.8300 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 92 96 127.461115 $6373.0800 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 5 6 5.866667 $88.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 867 999 1068.042868 $51800.1400 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 2.000000 $200.0000 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 7 7 18.000000 $900.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 3607 5816 7497.711624 $413318.3800 $55.1300
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.533333 $61.3300 $40.0000
ASST -ASST ASSISTIVE TECHNOLOGY 177 200 394.857935 $592286.5500 $1500.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 3 4.000000 $275.4400 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 6.071429 $418.0800 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 180 200 503.596916 $25179.8500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1061 1647 3329.818250 $166491.4200 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 45 47 57.352183 $1433.8000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3742 4894 12002.176906 $600108.4000 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 152 170 329.942846 $8248.5400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2335 2693 4957.029743 $247851.3500 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 56 58 103.812693 $2595.3000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2441 2852 6209.960682 $310497.8500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 58 62 88.578171 $2214.4400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4653 5726 10157.187231 $507858.9900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 157 169 303.663087 $7591.5600 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 17 22 76.528571 $5611.0800 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 5 6 1123.714286 $14046.4300 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 5 6 29.771429 $744.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 327 430 3771.914281 $94297.8600 $25.0000
EIIF -90846 FAMILY PSYCHOTHERAPY W/O PATIENT 1 1 8.000000 $400.0000 $50.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 12 14 284.152381 $14207.6300 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 0.844444 $42.2200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 29 31 286.723806 $14336.1900 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 6 6 20.214286 $505.3600 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 8884 11721 87711.561059 $4385577.2800 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 3 3 22.066667 $1103.3400 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 110 138 695.107536 $34755.3500 $50.0000
INTR -INTR INTERPRETER 260 364 2375.001597 $118750.0600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1987 2598 17016.257930 $1155063.5600 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 75 82 610.246430 $33148.6000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 2667 3522 22478.118184 $1525814.5900 $67.8800
PHY -97110HM PT SESSION BY PT ASST 96 100 642.572617 $34904.5500 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 730 830 5905.551568 $5905.5500 $1.0000
SENS -FM FM RECEIVER HEARING AID 2 2 2.333333 $3849.9500 $1649.9800
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 29 32 51.056546 $25528.3500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 20 23 28.677626 $1864.0400 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 4 5 3.866667 $440.8000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 15 16 38.666406 $8815.9200 $228.0000
SENS -V5264 EARMOLD 110 128 208.238337 $3748.2800 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 2 2 6.800000 $340.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 140 173 468.396026 $23419.7800 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 4086 5279 35247.542845 $2392603.2200 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 43.285715 $2351.2700 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 107 115 769.977772 $10163.7100 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 9 9 59.033334 $5903.3300 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 8961 16220 4539911.699118 $2269955.8700 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 10 12 48.246032 $2412.3100 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 105 134 740.477780 $37023.8800 $50.0000
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Subtotal (Total Children Is Unduplicated) 14221 60755 4759136.226014 $14700747.4800 $3.0900
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Total 66583 4766661.186844 $15115074.0800 $3.1700
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Number of Children (Unduplicated) With at Least One Authorization 14502