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: 10-01-12 and 12-31-12 Date of Report: 02-16-13 Page: 1
Child has a MEDICAID # Filter: Y
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
SCONLY-SCONLY SERVICE COORDINATION ONLY 408 451 2963.749201 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 1.888889 $69.8900 $37.0000
TCM -T1017TL TARGETED CASE MANAGEMENT 1 1 0.005479 $0.2000 $37.1400
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Subtotal (Total Children Is Unduplicated) 410 455 2965.643569 $70.0900 $0.0200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 108 124 50.379831 $2443.4200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 3 3 5.111110 $219.7200 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 74 76 26.830153 $350.1300 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 3 3.444444 $57.8000 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 78 80 30.285708 $275.9000 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 77 78 30.285708 $282.8600 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 77 79 30.296819 $658.3400 $21.7300
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 14 14 4.067579 $231.6000 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 66 68 26.296820 $643.4700 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 201 217 277.166208 $16629.9600 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 27 28 17.302510 $778.6100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 52 55 53.087734 $6105.0700 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 2 2 2.000000 $250.0000 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 9 9 2.026255 $101.3100 $50.0000
EXIT -EXIT EXIT ASSESSMENT 130 138 142.450376 $7122.5100 $50.0000
IPDEF -IPDEF FOLLOW-UP PSYCH AND DEV EVAL 4 5 3.397678 $254.8200 $75.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 25 25 31.032903 $2327.4600 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 0.016437 $1.2400 $75.2900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 1 1 0.011111 $0.8300 $74.9300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 6 6 0.061034 $4.5800 $74.9600
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 35 37 33.203764 $1842.8000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 128 128 7.573721 $567.9600 $74.9900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 28 28 6.155742 $461.6900 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 12 12 0.111110 $8.3300 $74.9300
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 42 42 9.267724 $514.3600 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 55 56 3.903374 $292.7600 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 21 23 9.045238 $438.7000 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 379 414 263.330786 $12771.5300 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 14 15 13.910317 $674.6400 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 349 392 149.701227 $7260.4700 $48.5000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.544444 $8.1700 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 397 431 252.963798 $12268.7000 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 13.815079 $1381.5100 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 3 3 1.557686 $77.8900 $50.0000
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Subtotal (Total Children Is Unduplicated) 1668 2600 1500.634428 $77309.1100 $51.5200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 61 74 71.140018 $106709.7000 $1500.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 1.144444 $78.8000 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 2 2 0.672222 $46.2900 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 69 72 199.234972 $9961.7500 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 283 350 118.801626 $5940.3200 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 21 24 34.744571 $868.6200 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2565 4384 8804.128140 $440207.6400 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 70 78 147.308340 $3682.7300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1817 2242 4621.467264 $231074.1000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 30 39 63.800001 $1595.0000 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1838 2256 4286.869586 $214344.1300 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 25 29 54.772223 $1369.3100 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2908 3524 5907.472781 $295374.4300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 73 76 127.176990 $3179.4400 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 10 13 45.076190 $3304.9900 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 13 13 1665.285718 $20816.0700 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 235 296 2602.466667 $65061.7200 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 3 3 31.552381 $1577.6200 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 5 5 29.593649 $1479.6900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5489 6797 53548.006223 $2677403.1200 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 9 9 48.521429 $2426.0700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 81 94 593.256726 $29662.8500 $50.0000
INTR -INTR INTERPRETER 116 141 1134.097355 $56704.9100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1167 1495 9804.738887 $665546.0400 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 24 26 138.195239 $7506.7600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1505 1927 12287.074985 $834047.2700 $67.8800
PHY -97110HM PT SESSION BY PT ASST 51 59 364.859525 $19819.1800 $54.3200
SENS -FM FM RECEIVER HEARING AID 2 2 14.909524 $24600.8400 $1650.0100
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 10 10 8.288889 $4144.4500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 14 15 10.689499 $694.8200 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 0.250000 $28.5000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 15 15 10.841095 $2471.7300 $228.0000
SENS -V5264 EARMOLD 52 55 68.809351 $1238.5500 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 10 19 37.827777 $1891.3900 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 79 91 263.957152 $13197.8900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1695 2154 14145.862721 $960221.7500 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 4 4 23.857143 $1295.9200 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 34 36 288.495240 $3808.1400 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 2 2 22.428572 $2242.8500 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 5370 10080 2202888.835192 $1101444.3700 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 19 20 103.460714 $5173.0400 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 85 106 685.150767 $34257.5600 $50.0000
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Subtotal (Total Children Is Unduplicated) 7860 36640 2325305.121788 $7856500.3100 $3.3800
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Total 39695 2329771.399785 $7933879.5100 $3.4100
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Number of Children (Unduplicated) With at Least One Authorization 8298