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 1 1 16.533333 $611.7300 $37.0000
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Subtotal (Total Children Is Unduplicated) 4 4 20.614286 $762.7300 $37.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 106 118 110.762704 $5372.0200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.266667 $10.4200 $39.0800
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 42 42 42.000000 $498.1200 $11.8600
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 42 42 42.000000 $347.7600 $8.2800
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 43 43 43.000000 $446.3400 $10.3800
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 43 43 43.000000 $906.4400 $21.0800
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 1.000000 $22.9600 $22.9600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 10 10 19.805556 $1025.1400 $51.7600
AUDE -92586 AUD EVOKED RESPONSE (SCREEN) 1 1 1.000000 $30.4900 $30.4900
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 37 37 37.000000 $1006.0300 $27.1900
AUDE -AUDE UNSPECIFIED AUDE SERVICES 52 56 46.783333 $2807.0000 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 4.011111 $180.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 17 18 15.227701 $1751.1900 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 3 3 3.000000 $375.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 13 13 21.000000 $1050.0000 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 425 456 837.209523 $41860.4800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 11 11 17.019444 $944.5800 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 38 38 74.500000 $5587.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 8 8 14.500000 $1087.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 81 81 71.933326 $3992.2600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 42 52 99.500000 $7462.5000 $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 8 8 2.916666 $141.4600 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 87 93 86.466668 $4193.6400 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 2 2 2.000000 $97.0000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 62 69 59.078573 $2865.3200 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 30 30 34.955560 $1747.8000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 1 2 1.600000 $24.0000 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 132 149 145.160317 $7040.2700 $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) 1056 1449 1912.697149 $95123.7000 $49.7300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 66 73 66.266665 $99399.7500 $1500.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $68.8600 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 87 101 235.362694 $11768.1300 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 1046 1629 3307.068250 $165353.9200 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 44 46 56.352183 $1408.8000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3704 4840 11790.369767 $589518.0500 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 152 170 329.942846 $8248.5400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2282 2630 4824.607128 $241230.2300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 55 57 103.679360 $2591.9700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2397 2797 6101.353942 $305067.5300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 58 62 88.578171 $2214.4400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4592 5643 9976.226919 $498810.9900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 155 167 299.196421 $7479.8900 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 185.714286 $2321.4300 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 3 3 17.971429 $449.2900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 72 74 698.928566 $17473.2100 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 10 11 254.866666 $12743.3400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 12 12 89.152380 $4457.6100 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 5 5 15.500000 $387.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 2115 2704 21356.072607 $1067803.4800 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 13.000000 $650.0000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 12 14 55.506348 $2775.3100 $50.0000
INTR -INTR INTERPRETER 260 364 2375.001597 $118750.0600 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 345 418 2527.034521 $171535.0700 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 11 12 69.797620 $3791.4100 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 394 484 2708.788094 $183872.4900 $67.8800
PHY -97110HM PT SESSION BY PT ASST 16 16 107.966667 $5864.7500 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 723 822 5712.723790 $5712.7200 $1.0000
SENS -FM FM RECEIVER HEARING AID 1 1 1.333333 $2199.9500 $1649.9600
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 11 12 14.466590 $7233.3000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 13 15 14.057534 $913.7400 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 2 1.600000 $182.4000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 4 2.711111 $618.1300 $228.0000
SENS -V5264 EARMOLD 24 25 26.699923 $480.6000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 23 26 41.257141 $2062.8500 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 938 1137 7522.739686 $510643.6100 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 29 30 188.070632 $2482.5300 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 9 9 59.033334 $5903.3300 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 8909 16067 4506676.918161 $2253338.4800 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 4 5 33.614286 $1680.7200 $50.0000
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Subtotal (Total Children Is Unduplicated) 12041 40490 4587950.530648 $6319488.3700 $1.3800
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Total 41943 4589883.842083 $6415374.8000 $1.4000
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Number of Children (Unduplicated) With at Least One Authorization 12252