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 1 1 0.250000 $9.2500 $37.0000
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Subtotal (Total Children Is Unduplicated) 5 5 1.938890 $71.7400 $37.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 126 154 98.924601 $4797.8300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 2.044444 $87.8900 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 27 27 27.000000 $352.3500 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.611111 $10.2500 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 27 27 27.000000 $245.9700 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 25 25 25.000000 $233.5000 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 26 26 26.000000 $564.9800 $21.7300
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 14 16 39.559523 $2252.5200 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 23 23 22.611111 $553.2900 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 57 62 92.644824 $5558.6800 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 3.477779 $156.5100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 15 15 11.405632 $1311.6600 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 2 2 4.000000 $500.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 16 19 34.000000 $1700.0000 $50.0000
EXIT -EXIT TRANSITION ASSESSMENT 425 455 729.379358 $36468.9200 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 10.288888 $771.6600 $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 4 4 5.733333 $430.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 6 6 8.288888 $460.0300 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 59 59 89.127775 $6684.5600 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 5 5 7.066667 $530.0000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 2 2 4.000000 $300.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 53 54 102.011111 $5661.6200 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 29 36 72.000000 $5400.0000 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 4 4 2.999207 $145.4600 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 89 92 80.869045 $3922.1300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 3 2.466667 $119.6400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 62 66 41.172220 $1996.8400 $48.5000
SCREEN-T1023 INTERDISCIPLINARY SCREENING 21 21 32.027780 $1601.4000 $50.0000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 3 3 2.868493 $43.0300 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 148 156 172.384842 $8360.6500 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 3.450793 $345.0800 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 3 3 5.252055 $262.6100 $50.0000
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Subtotal (Total Children Is Unduplicated) 1021 1386 1789.399480 $92109.0500 $51.4700
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 67 73 89.795869 $134693.8500 $1500.0000
AUD -92633 AUD REHAB POSTLING HEARING LOSS 1 1 1.000000 $68.8600 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 90 103 260.013634 $13000.6600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 686 852 570.313603 $28516.0200 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 35 38 62.036313 $1550.9200 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3701 6128 13998.049390 $699904.2600 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 113 132 264.257544 $6606.4500 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2614 3160 7508.272912 $375414.8600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 45 49 103.021034 $2575.5300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2583 3124 7056.566890 $352829.4900 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 37 40 73.477781 $1836.9500 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4435 5435 10276.720027 $513837.1700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 106 117 200.079368 $5001.9900 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 2 2 6.466666 $474.1300 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 150.000000 $1875.0000 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 2 3.866666 $96.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 58 61 708.395243 $17709.8800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 9 10 206.114286 $10305.7200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 6 63.428570 $3171.4400 $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 1939 2455 20644.898662 $1032245.6200 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 3 12.685715 $634.2900 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 11 12 51.149207 $2557.4700 $50.0000
INTR -INTR INTERPRETER 206 323 1990.358290 $99518.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 259 327 1918.623815 $130236.2600 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 11 12 88.780951 $4822.5800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 290 364 2225.582529 $151072.5800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 15 17 124.604761 $6768.5400 $54.3200
SCONLY-SCONLY SERVICE COORDINATION ONLY 615 706 8198.186505 $8198.1900 $1.0000
SENS -FM FM RECEIVER HEARING AID 2 2 9.638096 $15902.8700 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 13 13 12.293000 $6146.5500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 15 15 14.882800 $967.3800 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 2.533333 $288.8000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 3 3.514763 $801.3500 $228.0000
SENS -V5264 EARMOLD 21 21 22.457610 $404.2400 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 0.233333 $11.6700 $49.9900
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 24 32 78.325400 $3916.2900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 641 782 5600.180169 $380140.4200 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 8.428571 $457.8400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 26 28 194.231748 $2563.8600 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 5 5 42.519047 $4251.9100 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 8025 16183 3470321.956009 $1735160.9700 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 4 6 33.842857 $1692.1500 $50.0000
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Subtotal (Total Children Is Unduplicated) 10760 40648 3553214.049634 $5758536.3100 $1.6200
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Total 42039 3555005.388004 $5850717.1000 $1.6500
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Number of Children (Unduplicated) With at Least One Authorization 10926