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: 04-01-13 and 06-30-13 Date of Report: 08-18-13 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 218 240 304.989676 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 218 240 304.989676 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 77 97 31.081291 $1507.5000 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 19 19 5.166665 $67.4200 $13.0500
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 19 19 4.166665 $37.9600 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 19 19 4.166665 $38.9200 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 19 19 4.166665 $90.5400 $21.7300
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 1 2 0.505556 $28.7900 $56.9500
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 16 16 2.155554 $52.7400 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 14 17 6.594445 $395.6700 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 0.500000 $22.5000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 2 2 1.511111 $173.7800 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 3 3 0.202739 $10.1400 $50.0200
EXIT -EXIT EXIT ASSESSMENT 74 74 11.275876 $563.7900 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 1 1 0.008333 $0.6200 $74.7000
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 1 1 0.011111 $0.8300 $74.9300
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 14 14 0.141588 $10.6100 $74.9000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 1 1 0.005479 $0.4100 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 2 2 0.010958 $0.6100 $55.7000
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 1 1 0.172222 $8.3500 $48.4900
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 41 46 14.036510 $680.7800 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 3 3 0.366666 $17.7800 $48.4900
PSTH -97001 EVAL BY LICENSED PT, INITIAL 26 29 9.700003 $470.4600 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 47 55 31.608734 $1533.0400 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.355556 $35.5600 $100.0100
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Subtotal (Total Children Is Unduplicated) 303 442 127.910392 $5748.8000 $44.9400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 18 22 8.772225 $43862.5000 $5000.1600
AUD -HA_FUP AUDIOLOGY SERVICES 24 27 80.100010 $4005.0000 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 316 396 36.517234 $1826.1700 $50.0100
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 20 20 1.529133 $38.2400 $25.0100
CONIF -CONIF CONSULT ITDS, FACE TO FACE 1798 2572 4177.204391 $208859.5900 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 54 64 120.549997 $3013.7400 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 1510 1973 3420.699549 $171034.2900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 18 22 30.438887 $760.9700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 1515 1988 3345.314551 $167265.0800 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 21 25 44.033334 $1100.8400 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 2344 3054 4621.346440 $231066.6700 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 39 43 75.869840 $1896.7400 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 13 13 95.999998 $2400.0000 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 0.533333 $26.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 225 294 1922.207941 $96110.3600 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 1 1 0.833333 $41.6700 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 1 1 5.714286 $285.7200 $50.0000
INTR -INTR INTERPRETER 64 94 726.686139 $36334.2900 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 97 116 703.448813 $47750.1400 $67.8800
PHY -97110 PT SESSION BY LICENSED PT 131 158 894.419844 $60713.2400 $67.8800
PHY -97110HM PT SESSION BY PT ASST 2 2 17.304762 $939.9900 $54.3200
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 4 4 1.566668 $783.4000 $500.0400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 6 7 4.759742 $309.3900 $65.0000
SENS -V5264 EARMOLD 8 9 5.305557 $95.5000 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 6 7 9.983334 $499.1700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 184 245 1523.015473 $103382.2700 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 1 1 2.714286 $35.8300 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1259 1774 12100.534958 $121005.3200 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 2999 5336 1123628.734773 $561814.3800 $0.5000
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Subtotal (Total Children Is Unduplicated) 4938 18269 1157606.138831 $1867257.1300 $1.6100
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Total 18951 1158039.038899 $1873005.9300 $1.6200
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Number of Children (Unduplicated) With at Least One Authorization 5204