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 298 345 420.424601 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 298 345 420.424601 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 93 119 34.788280 $1687.2300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 0.677778 $29.1400 $42.9900
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 34 34 0.377774 $4.9300 $13.0400
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 2 2 0.511111 $8.5800 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 35 35 0.477774 $4.3500 $9.1000
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 35 35 0.477774 $4.4600 $9.3300
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 33 33 0.366663 $7.9600 $21.7100
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.100000 $2.5300 $25.2600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 7 7 3.104763 $176.7900 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 31 31 0.744441 $18.2100 $24.4600
AUDE -AUDE UNSPECIFIED AUDE SERVICES 34 39 13.843611 $830.6400 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 4 1.738889 $78.2500 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 9 9 3.982041 $457.9500 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 2 2 0.092466 $4.6200 $49.9600
EXIT -EXIT EXIT ASSESSMENT 74 75 23.338052 $1166.9000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 0.027778 $2.0900 $75.0600
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 54 54 0.793581 $59.4800 $74.9500
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 4 4 0.033256 $2.4900 $74.8700
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 13 13 0.522479 $29.0000 $55.5100
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 4 4 0.033180 $2.4900 $75.0500
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 4 4 0.611112 $29.6400 $48.5100
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 94 100 33.449999 $1622.3200 $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 72 81 25.488889 $1236.2100 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 167 177 68.620628 $3328.0700 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 10.785714 $1078.5700 $100.0000
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Subtotal (Total Children Is Unduplicated) 578 870 225.488033 $11897.1300 $52.7600
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 31 40 27.030366 $135152.0000 $5000.0100
AUD -HA_FUP AUDIOLOGY SERVICES 19 23 44.181496 $2209.0900 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 506 624 13.497464 $675.3500 $50.0300
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 24 24 7.623578 $190.6000 $25.0000
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2511 3408 5891.674083 $294583.7300 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 63 85 149.461110 $3736.5300 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2236 3026 5133.527566 $256676.3200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 21 23 41.355557 $1033.8900 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2096 2812 4710.292055 $235514.5500 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 21 26 48.966666 $1224.1700 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3390 4557 6738.155045 $336907.7900 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 52 69 113.417460 $2835.4400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 22 23 187.649967 $4691.2500 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1376 1836 13211.287372 $660563.6100 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 5.533333 $276.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 2 12.857142 $642.8600 $50.0000
INTR -INTR INTERPRETER 57 85 758.711741 $37935.5900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 236 296 1784.198019 $121111.2900 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 4 4 15.342857 $833.4300 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 249 325 1801.213092 $122266.3200 $67.8800
PHY -97110HM PT SESSION BY PT ASST 2 2 19.285714 $1047.6000 $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 7 9 2.744445 $1372.2500 $500.0100
SENS -HA_INS SENSORY AID INSURANCE PER EAR 7 8 1.469863 $95.5400 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 1 1 1.000000 $228.0000 $228.0000
SENS -V5264 EARMOLD 18 23 10.732039 $193.1800 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 23 33 34.581745 $1729.0900 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 546 674 4314.767468 $292886.1700 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 6 6 30.571428 $403.5400 $13.2000
TRAN -TRAN FAMILY TRANSPORTATION 1 1 0.477778 $47.7800 $100.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 4409 8714 1683674.781705 $841837.4200 $0.5000
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Subtotal (Total Children Is Unduplicated) 6572 26761 1728786.888154 $3359726.0000 $1.9400
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Total 27976 1729432.800788 $3371623.1300 $1.9500
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Number of Children (Unduplicated) With at Least One Authorization 6933