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
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 508 558 3485.617451 $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) 510 562 3487.511819 $70.0900 $0.0200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 142 168 69.629829 $3377.0300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 5 5 6.572221 $282.5300 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 110 112 36.885706 $481.3500 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 8 8 6.185388 $103.7900 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 118 120 41.585705 $378.8400 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 117 118 41.788293 $390.3000 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 117 119 41.173681 $894.6800 $21.7300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.377778 $9.5400 $25.2600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 28 28 26.032659 $1482.3000 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 95 97 31.074595 $760.3700 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 290 315 522.901291 $31374.0500 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 46 48 30.374730 $1366.8500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 87 94 89.181286 $10255.8200 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 5 5 7.066667 $883.3400 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 14 15 3.520700 $176.0400 $50.0000
EXIT -EXIT EXIT ASSESSMENT 170 182 188.912781 $9445.6300 $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 41 41 48.088077 $3606.6000 $75.0000
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 4 4 0.021916 $1.6500 $75.2900
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 1.041666 $78.1200 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 8 8 1.094367 $82.0700 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 48 50 49.259014 $2733.8700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 185 185 10.275650 $770.5700 $74.9900
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 34 34 6.399956 $480.0100 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 22 22 0.211108 $15.8100 $74.8900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 57 57 9.383777 $520.8000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 67 68 6.000289 $450.0200 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 31 33 13.665080 $662.7600 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 581 631 370.493941 $17968.8900 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 18 19 15.049206 $729.8800 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 514 579 262.396132 $12726.1400 $48.5000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 4 4 1.167427 $17.5100 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 730 814 502.181274 $24355.7300 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 13.815079 $1381.5100 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 4 4 1.735464 $86.7800 $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) 2548 4000 2459.940411 $128634.5100 $52.2900
EI Services, Class # 03
AACFIT-92609 AAC FITTING, ADJUST, TRAINING VISIT 1 1 1.033333 $41.3300 $40.0000
ASST -ASST ASSISTIVE TECHNOLOGY 111 128 159.135623 $238702.6500 $1500.0000
AUD -92630 AUD REHAB PRELING HEARING LOSS 2 2 1.144444 $78.8000 $68.8600
AUD -92633 AUD REHAB POSTLING HEARING LOSS 3 3 2.029365 $139.7400 $68.8600
AUD -HA_FUP AUDIOLOGY SERVICES 114 122 299.190234 $14959.5200 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 448 575 346.592086 $17329.9600 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 29 32 37.945762 $948.6600 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3731 6205 13641.865056 $682094.9600 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 84 94 185.348023 $4633.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2744 3417 7435.923190 $371797.2100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 38 49 78.285715 $1957.1500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2641 3282 6791.873624 $339594.6600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 32 36 69.855558 $1746.4000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4371 5378 9789.742784 $489488.3100 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 93 96 174.707150 $4367.7000 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 14 17 54.076190 $3964.8700 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 14 14 1731.000004 $21637.5000 $12.5000
EIGF -EIGF_NM EI GROUP SESSION BY NONMED PROF 1 1 4.866667 $121.6700 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 289 356 3282.142861 $82053.6400 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 6 6 58.866667 $2943.3400 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 6 6 29.938093 $1496.9100 $50.0000
EIIF -T1027HM EI INDIVIDUAL SESSION BY PARAPROF 1 1 5.200000 $130.0000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 7299 9037 71814.845409 $3590745.9500 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 22 22 107.296429 $5364.8200 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 109 129 761.940061 $38097.0400 $50.0000
INTR -INTR INTERPRETER 124 151 1202.935449 $60146.8200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1700 2205 14532.533983 $986469.0200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 32 34 179.233334 $9735.9600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 2122 2740 17704.043155 $1201751.2300 $67.8800
PHY -97110HM PT SESSION BY PT ASST 73 82 529.135717 $28742.6600 $54.3200
SENS -FM FM RECEIVER HEARING AID 4 5 15.453968 $25499.1000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 30 30 24.911416 $12455.7000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 19 20 14.802132 $962.1400 $65.0000
SENS -V5014 HEARING AID REPAIR BY MANUFACTURER 1 1 0.250000 $28.5000 $114.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 21 22 20.656903 $4709.7300 $228.0000
SENS -V5264 EARMOLD 95 109 127.276906 $2290.9600 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 17 28 71.494444 $3574.7200 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 108 123 364.339694 $18217.0200 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2953 3826 25714.050018 $1745470.7500 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 6 6 32.857143 $1784.8000 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 61 63 533.842859 $7046.7300 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 2 2 22.428572 $2242.8500 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 7369 14012 3142402.227974 $1571201.0500 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 25 29 142.528572 $7126.4300 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 106 134 803.405528 $40170.3100 $50.0000
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Subtotal (Total Children Is Unduplicated) 11103 52631 3321303.252095 $11644062.9000 $3.5100
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Total 57193 3327250.704325 $11772767.5100 $3.5400
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Number of Children (Unduplicated) With at Least One Authorization 11661