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: 01-01-13 and 03-31-13 Date of Report: 05-17-13 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 242 282 323.657933 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 242 282 323.657933 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 81 105 30.543836 $1481.3800 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 1.000000 $42.9900 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 88 88 0.988879 $12.9000 $13.0400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 3 4 1.866667 $31.3200 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 91 92 2.866657 $26.1000 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 91 92 2.866657 $26.7700 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 88 90 3.238880 $70.3600 $21.7200
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 14 14 4.427777 $252.1100 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 79 79 1.383324 $33.8300 $24.4500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 111 127 58.489580 $3509.4100 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 12 14 3.213547 $144.6100 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 24 28 13.910732 $1599.7500 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.092466 $4.6200 $49.9600
EXIT -EXIT EXIT ASSESSMENT 56 56 17.112937 $855.6400 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 0.055479 $4.1600 $75.0300
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 2 2 0.016590 $1.2500 $75.0500
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.016590 $1.2500 $75.0500
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 0.022069 $1.2300 $55.5700
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 122 122 1.011774 $75.8600 $74.9700
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 23 23 0.120813 $9.0700 $75.0500
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 49 49 0.292989 $16.2800 $55.5700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 42 42 0.292686 $21.9500 $75.0000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 13 13 3.933335 $190.7700 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 389 454 189.568560 $9194.0200 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 11 11 15.173810 $735.9300 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 331 407 130.380217 $6323.4200 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 345 388 130.682337 $6338.1200 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 3 3 11.257936 $1125.7900 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 2 0.500000 $25.0000 $50.0000
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Subtotal (Total Children Is Unduplicated) 1381 2320 625.327124 $32155.8800 $51.4200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 43 42.920015 $214600.0000 $5000.0000
AUD -HA_FUP AUDIOLOGY SERVICES 18 22 41.468797 $2073.4600 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 321 399 8.758866 $438.2700 $50.0400
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 18 18 7.611077 $190.2900 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1671 2254 3958.756068 $197937.7700 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 53 71 126.233333 $3155.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1458 1954 3332.041740 $166602.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 19 21 35.355557 $883.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1426 1883 3124.712685 $156235.5700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 17 22 39.733333 $993.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2216 2954 4356.303157 $217815.1300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 41 56 93.267460 $2331.6900 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 17 18 1625.857141 $20323.2100 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 169 222 1948.299994 $48707.4800 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 6 7 3.866666 $193.3300 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 3556 4866 35463.040598 $1773150.2900 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 19 26 144.083333 $7204.1700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 33 49 229.891667 $11494.5800 $50.0000
INTR -INTR INTERPRETER 52 79 721.706185 $36085.3100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1087 1457 8859.554379 $601386.0500 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 11 11 48.142856 $2615.1200 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1273 1736 9871.285705 $670062.5900 $67.8800
PHY -97110HM PT SESSION BY PT ASST 20 22 118.928567 $6460.2100 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 5 7 2.038889 $1019.4500 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 8 1.453881 $94.5000 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 10 12 3.869710 $882.2700 $227.9900
SENS -V5264 EARMOLD 33 44 26.188888 $471.4000 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 16 22 77.044445 $3852.2300 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 45 59 166.253968 $8312.7000 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 1375 1854 11071.239478 $751515.2600 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 3 3 7.857142 $426.8000 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 15 15 94.278572 $1244.4800 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.477778 $47.7800 $100.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 3197 6182 1112400.547160 $556200.2900 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 28 36 158.538889 $7926.9500 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 36 54 323.257143 $16162.8400 $50.0000
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Subtotal (Total Children Is Unduplicated) 5476 26487 1198534.865122 $5489096.4900 $4.5800
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Total 29089 1199483.850179 $5521252.3700 $4.6000
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Number of Children (Unduplicated) With at Least One Authorization 5726