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: 07-01-12 and 09-30-12 Date of Report: 11-15-12 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
SCTT -SCTT SERVICE COORDINATOR TRAVEL 4 4 1.688890 $62.4900 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 3 3 2.550000 $94.3500 $37.0000
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Subtotal (Total Children Is Unduplicated) 7 7 4.238890 $156.8400 $37.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 146 177 115.441267 $5598.8900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 7 7.511111 $322.9000 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 81 81 80.288889 $1047.7700 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 12 13 10.678463 $179.1900 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 93 94 90.244446 $822.1300 $9.1100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 1.000000 $23.4500 $23.4500
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 91 92 89.833334 $839.0400 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 94 94 92.489574 $2009.8000 $21.7300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.188889 $4.7700 $25.2600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 28 30 48.676190 $2771.6200 $56.9400
AUDE -92586 AUD EVOKED RESPONSE (SCREEN) 1 1 1.000000 $33.5400 $33.5400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 59 59 57.033334 $1395.6100 $24.4700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 1.000000 $27.2800 $27.2800
AUDE -AUDE UNSPECIFIED AUDE SERVICES 379 417 440.316609 $26418.9800 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 47 51 40.972682 $1843.7900 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 105 113 165.591868 $19043.0700 $115.0000
BEHV -BEHV BEHAVIORAL ASSESSMENT 1 1 1.000000 $125.0000 $125.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 8 8 23.571429 $2946.4300 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 46 54 50.716666 $2535.8300 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 436 470 764.524956 $38226.2000 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 7 10 11.666667 $875.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 61 62 104.842442 $7863.1700 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 1 1 1.500000 $112.5000 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.233333 $17.5000 $74.9900
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 12 13 21.744444 $1630.8300 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 67 68 107.133712 $5945.9100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 358 358 642.680245 $48200.9900 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 73 73 131.066667 $9830.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 13 13 26.000000 $1950.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 320 323 616.594214 $34220.9800 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 247 297 571.072145 $42830.4100 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 38 40 21.360319 $1035.9800 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 581 667 460.995188 $22358.1800 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 16 17 7.669843 $372.0000 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 522 636 409.324772 $19852.1900 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 48 48 76.055560 $3802.8000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 6 7 7.224048 $108.3600 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 761 848 713.185935 $34589.5000 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 3.450793 $345.0800 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 4 4 6.252055 $312.6100 $50.0000
WHEELP-97001TG WHEELCHAIR EVAL/ FITTING BY LICENSE 1 1 1.000000 $48.5000 $48.5000
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Subtotal (Total Children Is Unduplicated) 3250 5255 6023.132089 $342517.7600 $56.8700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 144 161 320.922841 $481384.3500 $1500.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 3 3 3.022222 $208.1100 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 7.676985 $528.6400 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 134 153 361.575215 $18078.7500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 698 865 585.527889 $29276.7400 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 35 38 62.036313 $1550.9200 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3728 6189 14106.551771 $705329.4000 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 113 132 264.257544 $6606.4500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2642 3198 7572.485614 $378625.5100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 45 49 103.021034 $2575.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2609 3162 7127.429987 $356372.6500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 37 40 73.477781 $1836.9500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4479 5485 10390.150983 $519508.7000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 107 119 206.936510 $5173.4200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 20 27 94.214286 $6907.7900 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 10 10 984.428571 $12305.3600 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 2 3 9.999999 $250.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 321 411 3071.700001 $76792.5200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 10 11 258.685715 $12934.2900 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 8 8 65.849205 $3292.4800 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 12.266667 $306.6700 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7843 10602 80068.072473 $4003407.0700 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 2 5 19.257144 $962.8600 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 116 150 777.565086 $38878.2800 $50.0000
INTR -INTR INTERPRETER 206 323 1990.358290 $99518.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1710 2312 14478.335115 $982789.8600 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 51 54 376.508332 $20451.9400 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 2260 3031 18810.234352 $1276839.3100 $67.8800
PHY -97110HM PT SESSION BY PT ASST 91 101 662.370240 $35979.9600 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 619 712 8288.117457 $8288.1200 $1.0000
SENS -FM FM RECEIVER HEARING AID 3 3 10.271429 $16947.8100 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 31 34 40.420016 $20210.0500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 21 21 29.357077 $1908.2100 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 3 3 4.044444 $461.0600 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 19 20 42.935638 $9789.3600 $228.0000
SENS -V5264 EARMOLD 101 120 188.847280 $3399.2500 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 8 9 9.344444 $467.2200 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 120 149 485.986515 $24299.3600 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 3213 4174 28349.907583 $1924392.8000 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 5 5 47.857142 $2599.6100 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 85 96 690.043656 $9108.5800 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 5 5 42.519047 $4251.9100 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 8066 16344 3511796.379825 $1755898.1800 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 12 15 78.668651 $3933.4400 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 109 140 835.570239 $41778.5500 $50.0000
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Subtotal (Total Children Is Unduplicated) 12232 58496 3713805.188608 $12906405.9800 $3.4800
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Total 63758 3719832.559587 $13249080.5800 $3.5600
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Number of Children (Unduplicated) With at Least One Authorization 12429