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
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 299 346 420.924601 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 299 346 420.924601 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 110 142 47.154414 $2286.9900 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 2 1.000000 $42.9900 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 130 130 1.455541 $18.9800 $13.0400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 9 10 3.757838 $63.0600 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 140 141 6.261096 $57.0200 $9.1100
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.011111 $0.2600 $23.4300
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 141 142 6.447397 $60.2100 $9.3400
AUDE -92568 ACOUSTIC REFLEX TESTING (MEMR) 1 1 0.011111 $0.0900 $7.9200
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 136 138 6.671903 $144.9500 $21.7300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.100000 $2.5300 $25.2600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 26 26 9.909524 $564.2400 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 118 118 2.277764 $55.7000 $24.4500
AUDE -AUDE UNSPECIFIED AUDE SERVICES 161 188 80.949860 $4857.0700 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 23 26 8.174658 $367.8600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 45 50 23.770703 $2733.6800 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 3 3 0.220244 $11.0100 $49.9900
EXIT -EXIT EXIT ASSESSMENT 76 77 23.682496 $1184.1200 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 9 9 0.086034 $6.4500 $74.9700
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 0.024923 $1.8700 $74.9300
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 192 192 2.889104 $216.6200 $74.9800
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 37 37 1.210537 $90.8000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 73 73 0.889855 $49.4200 $55.5400
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 52 52 0.356002 $26.7100 $75.0200
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 19 19 4.877780 $236.5800 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 569 671 254.774118 $12356.5100 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 12 12 15.351588 $744.5500 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 500 614 207.768640 $10076.7600 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 638 734 261.537808 $12684.6300 $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) 2127 3622 983.418644 $50094.8900 $50.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 60 78 74.547413 $372738.0000 $5000.0100
AUD -HA_FUP AUDIOLOGY SERVICES 38 45 73.537354 $3676.8900 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 511 634 13.541016 $677.5200 $50.0300
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 24 24 7.623578 $190.6000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2517 3422 5910.907416 $295545.3900 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 63 85 149.461110 $3736.5300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2241 3033 5142.660899 $257132.9800 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 21 23 41.355557 $1033.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2103 2821 4728.858721 $236442.8800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 21 26 48.966666 $1224.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3394 4564 6747.421711 $337371.1200 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 52 69 113.417460 $2835.4400 $25.0000
ECE -ECE EARLY CHILDHOOD EDUCATION 19 20 1753.428570 $21917.8600 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 208 266 2402.016626 $60050.3900 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 7 8 4.122222 $206.1100 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 4781 6525 47578.212096 $2378908.1200 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 35 46 234.558333 $11727.9200 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 45 68 339.201189 $16960.0600 $50.0000
INTR -INTR INTERPRETER 57 85 758.711741 $37935.5900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1565 2130 13060.299615 $886532.4300 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 16 16 95.828571 $5205.4000 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1791 2472 14357.135696 $974561.9800 $67.8800
PHY -97110HM PT SESSION BY PT ASST 27 30 163.285710 $8869.6900 $54.3200
SENS -FM FM RECEIVER HEARING AID 1 1 0.500000 $825.0000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 16 19 7.490335 $3745.2000 $500.0000
SENS -HA_INS SENSORY AID INSURANCE PER EAR 10 11 2.880974 $187.2600 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 13 16 6.491932 $1480.1300 $228.0000
SENS -V5264 EARMOLD 66 84 53.559586 $964.0700 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 21 28 98.900001 $4945.0100 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 65 88 194.577778 $9728.8900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2427 3307 20332.025953 $1380136.8200 $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 23 23 118.535714 $1564.6700 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.477778 $47.7800 $100.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 4415 8735 1687636.299165 $843818.1700 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 32 42 187.338889 $9366.9500 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 48 70 407.890477 $20394.5100 $50.0000
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Subtotal (Total Children Is Unduplicated) 7809 38918 1812853.924994 $8193112.1800 $4.5200
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Total 42886 1814258.268239 $8243207.0700 $4.5400
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Number of Children (Unduplicated) With at Least One Authorization 8134