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 507 556 3484.484117 $0.0000 $0.0000
SCTT -SCTT SERVICE COORDINATOR TRAVEL 3 3 1.888889 $69.8900 $37.0000
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Subtotal (Total Children Is Unduplicated) 508 559 3486.373006 $69.8900 $0.0200
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 124 148 60.868719 $2952.1200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.222222 $52.5400 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 30 31 10.233331 $133.5400 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 1.022222 $17.1500 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 31 10.233331 $93.2200 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 30 31 10.233331 $95.5800 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 30 31 10.233331 $222.3700 $21.7300
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 12 12 21.165080 $1205.1500 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 26 27 10.211109 $249.8600 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 49 56 97.676714 $5860.6100 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 6 6 4.411111 $198.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 14 14 9.624886 $1106.8800 $115.0000
BEHV -H0031HO COMP BEHAVIORAL HEALTH ASSESSMENT 2 2 4.066667 $508.3400 $125.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 3 3 1.009589 $50.4800 $50.0000
EXIT -EXIT EXIT ASSESSMENT 165 173 175.593625 $8779.6800 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 7 7 4.077701 $305.8300 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 2 2 1.030555 $77.2900 $75.0000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 1.033333 $77.5000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 4 4 4.049923 $224.7700 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 58 58 4.028949 $302.1200 $74.9900
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 14 14 0.133331 $9.9800 $74.8700
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 10 10 0.094290 $5.2300 $55.4400
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 9 9 3.565144 $267.3800 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 4 4 3.386508 $164.2500 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 97 101 81.444914 $3950.0900 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 4 4 1.061111 $51.4600 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 64 69 31.950790 $1549.6000 $48.5000
SENS -V5014TS HEARING AID REPAIR IN-OFFICE 2 2 0.439649 $6.5900 $15.0000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 162 178 97.072931 $4708.0500 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 13.303968 $1330.4000 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 2 2 1.046575 $52.3300 $50.0000
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Subtotal (Total Children Is Unduplicated) 743 1035 675.524940 $34608.8700 $51.2300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 53 61 76.556870 $114835.0500 $1500.0000
AUD -HA_FUP AUDIOLOGY SERVICES 74 77 213.793071 $10689.6600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 447 573 336.160775 $16808.4000 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 29 32 37.945762 $948.6600 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 3711 6151 13514.070602 $675705.1900 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 84 94 185.348023 $4633.7200 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2729 3400 7395.268428 $369764.4700 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 38 49 78.285715 $1957.1500 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2623 3260 6734.911718 $336746.5700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 32 36 69.855558 $1746.4000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 4345 5349 9717.882462 $485895.2900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 91 94 159.364293 $3984.1200 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 3 3 3.266667 $239.5100 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 1 1 328.571429 $4107.1400 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 33 38 284.466672 $7111.6800 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 5 5 44.009524 $2200.4800 $50.0000
EIIF -EIIF_NM EI INDIVIDUAL SESSION BY NONMED PRO 4 4 28.571427 $1428.5800 $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 1822 2235 18321.634432 $916082.5300 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 6.133333 $306.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 6 7 27.261904 $1363.1000 $50.0000
INTR -INTR INTERPRETER 124 151 1202.935449 $60146.8200 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 250 323 1965.711117 $133432.5900 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 9 10 45.400000 $2466.1300 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 275 356 2119.715864 $143886.4000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 7 7 63.000001 $3422.1600 $54.3200
SENS -FM FM RECEIVER HEARING AID 3 4 15.420635 $25444.1600 $1650.0100
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 13 13 11.154262 $5577.1500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 13 14 9.343076 $607.3000 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 3 4 3.445966 $785.6700 $228.0000
SENS -V5264 EARMOLD 15 19 16.618643 $299.1300 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 1 1 0.800000 $40.0000 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 24 25 86.230955 $4311.5500 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 594 759 5061.681744 $343587.1400 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 1 1 5.571429 $302.6400 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 15 16 128.885714 $1701.2900 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 2 2 22.428572 $2242.8500 $100.0000
TRAV -TRAV PROVIDER TRAVEL TO NATURAL ENVIRONM 7334 13900 3106527.779559 $1553263.8300 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 3 3 31.200000 $1560.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 9668 37079 3174885.881651 $5239761.1300 $1.6500
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Total 38673 3179047.779597 $5274439.8900 $1.6600
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Number of Children (Unduplicated) With at Least One Authorization 10243