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 76 99 27.816059 $1349.0900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.677778 $29.1400 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 30 30 0.333330 $4.3500 $13.0400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.411111 $6.9000 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 30 30 0.333330 $3.0300 $9.1000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 30 30 0.333330 $3.1100 $9.3300
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 29 29 0.322219 $6.9900 $21.7100
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 1 1 0.500000 $28.4700 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 27 27 0.699997 $17.1200 $24.4600
AUDE -AUDE UNSPECIFIED AUDE SERVICES 19 23 9.083335 $545.0100 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 2 2 0.394445 $17.7500 $45.0100
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 1.716667 $197.4200 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.092466 $4.6200 $49.9600
EXIT -EXIT EXIT ASSESSMENT 55 55 16.940715 $847.0300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 2 2 0.016667 $1.2500 $75.1500
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 20 20 0.199921 $14.9800 $74.9200
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.405556 $19.6700 $48.5100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 40 41 17.083333 $828.5400 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 1 1 0.500000 $24.2500 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 31 33 9.866667 $478.5300 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 57 62 20.283331 $983.7300 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 10.785714 $1078.5700 $100.0000
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Subtotal (Total Children Is Unduplicated) 308 497 118.801450 $6489.9700 $54.6300
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 20 26 14.559589 $72798.0000 $5000.0000
AUD -HA_FUP AUDIOLOGY SERVICES 15 19 40.007936 $2000.4100 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 320 395 8.738032 $437.2200 $50.0400
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 18 18 7.611077 $190.2900 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1668 2246 3947.289401 $197364.4400 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 53 71 126.233333 $3155.8300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1457 1951 3329.041740 $166452.0100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 19 21 35.355557 $883.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1424 1880 3115.712685 $155785.5700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 17 22 39.733333 $993.3300 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2215 2951 4353.303157 $217665.1300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 41 56 93.267460 $2331.6900 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 10 11 74.933333 $1873.3300 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 219 291 1816.571433 $90828.5000 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 5.533333 $276.6700 $50.0000
INTR -INTR INTERPRETER 52 79 721.706185 $36085.3100 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 103 131 717.421429 $48698.5600 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 3 3 6.628571 $360.0700 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 130 173 885.558337 $60111.7000 $67.8800
PHY -97110HM PT SESSION BY PT ASST 1 1 6.428571 $349.2000 $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 6 7 1.420548 $92.3300 $65.0000
SENS -V5264 EARMOLD 8 10 4.366666 $78.6000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 8 10 11.391269 $569.5700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 190 237 1526.341274 $103607.9900 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 12.857143 $169.7100 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.477778 $47.7800 $100.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 3196 6174 1110347.696367 $555173.8700 $0.5000
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Subtotal (Total Children Is Unduplicated) 4542 16793 1131252.224426 $1719400.4200 $1.5200
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Total 17572 1131694.683809 $1725890.3900 $1.5300
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Number of Children (Unduplicated) With at Least One Authorization 4810