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
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 270 302 388.261896 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 270 302 388.261896 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 114 152 45.440196 $2203.9100 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 103 104 26.033324 $339.7300 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 10 10 4.972223 $83.4400 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 114 116 30.749992 $280.1200 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 116 117 30.972214 $289.2700 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 113 116 30.783325 $668.9000 $21.7300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.505556 $12.7700 $25.2600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 31 33 21.755557 $1238.7700 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 82 83 19.783327 $484.0800 $24.4700
AUDE -92588 OTOACOUSTIC EMISSIONS (COMP) 1 1 0.072222 $1.9700 $27.2700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 168 186 134.165152 $8049.9500 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 24 30 20.794350 $935.7600 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 45 54 35.090534 $4035.4400 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 4 4 0.213698 $10.6900 $50.0200
EXIT -EXIT EXIT ASSESSMENT 100 100 16.544218 $827.2100 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 8 8 0.083179 $6.2300 $74.9300
IPDEF -T1024GOTS F/U PSYCH AND DEV EVAL BY OT 3 3 0.019291 $1.4500 $75.0300
IPDEF -T1024TLTS F/U PSYCH AND DEV EVAL BY EI PROF 2 2 0.022222 $1.6700 $74.9300
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 2 2 0.010958 $0.6100 $55.7000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 192 192 2.369595 $177.7400 $75.0100
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 45 45 1.043146 $78.2700 $75.0300
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 1 1 0.005556 $0.4200 $75.5900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 105 105 0.824374 $45.8100 $55.5600
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 46 46 0.346798 $26.0200 $75.0200
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 22 25 18.632541 $903.6800 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 621 735 348.544371 $16904.6800 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 21 22 5.988640 $290.4600 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 531 647 235.873610 $11440.2100 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 660 753 364.710107 $17688.7400 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 2 2 13.212699 $1321.2700 $100.0000
VISF -VISF VISION EVALUATION FUNCTIONAL 1 1 0.505556 $25.2800 $50.0000
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Subtotal (Total Children Is Unduplicated) 2293 3696 1410.068531 $68374.5500 $48.4900
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 69 77 62.132956 $310666.0000 $5000.0200
AUD -HA_FUP AUDIOLOGY SERVICES 49 58 120.393400 $6019.6700 $50.0000
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 512 647 138.608512 $6930.9500 $50.0000
COIFP -COIFP IFSP CONSULT, PRO, BY PHONE 30 30 1.572058 $39.3100 $25.0100
CONIF -CONIF CONSULT ITDS, FACE TO FACE 2694 3825 6287.978333 $314397.9700 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 61 73 140.016663 $3500.4100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2335 3099 5333.445574 $266671.2900 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 21 26 36.705553 $917.6300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2234 2974 5063.431150 $253170.5700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 24 29 50.500001 $1262.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3584 4724 7086.790422 $354338.4600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 46 51 93.436506 $2335.9100 $25.0000
COUN -H2019HR INDIVIDUAL/FAMILY THERAPY 1 1 1.066667 $78.2100 $73.3200
ECE -ECE EARLY CHILDHOOD EDUCATION 18 22 3464.714287 $43308.9300 $12.5000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 171 240 1842.755916 $46068.8900 $25.0000
EIIF -90812 INDIVIDUAL PSYCHOTHERAPY, 45-50 MIN 1 1 0.688889 $34.4500 $50.0000
EIIF -COUN UNSPECIFIED COUNSELING 2 2 0.888889 $44.4500 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 5218 7015 51411.254806 $2570562.3200 $50.0000
HERN -EIIF_NM EI HEARING SERVICES AFTER SHINE NON 29 32 142.300000 $7115.0000 $50.0000
HERN -T1027SC EI HEARING SERVICES AFTER SHINE 59 71 410.322224 $20516.1200 $50.0000
INTR -INTR INTERPRETER 67 99 737.825028 $36891.2400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 1584 2147 13610.576613 $923885.8200 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 13 16 84.688095 $4600.2600 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 1884 2528 15109.502610 $1025633.1400 $67.8800
PHY -97110HM PT SESSION BY PT ASST 32 35 178.240475 $9682.0300 $54.3200
SENS -FM FM RECEIVER HEARING AID 1 1 0.450000 $742.5000 $1650.0000
SENS -HA_EIP ONE UNIT UP TO $500 PER AID 16 18 6.311494 $3155.8500 $500.0200
SENS -HA_INS SENSORY AID INSURANCE PER EAR 9 11 6.364612 $413.7000 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 19 22 12.241707 $2791.1500 $228.0000
SENS -V5264 EARMOLD 76 91 67.543599 $1215.7900 $18.0000
SHIN -EIIF_NM INITIAL SHINE SERVICES, IND NONMED 14 15 45.566667 $2278.3400 $50.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 70 85 224.013492 $11200.6700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2556 3368 21523.233342 $1460996.8200 $67.8800
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 2 2 5.785714 $314.2800 $54.3200
SPL -92508 GROUP SPL SESSION PER CHILD 22 23 137.500003 $1815.0000 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1721 2474 16510.585777 $165105.8100 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 4104 7554 1684762.369498 $842381.2000 $0.5000
VISN -EIIF_NM EI VISION SERVICES, IND NONMED 31 35 162.938889 $8146.9500 $50.0000
VISN -T1027SC EI VISION SERVICES, INDIVIDUAL 52 70 371.302382 $18565.1300 $50.0000
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Subtotal (Total Children Is Unduplicated) 8455 41591 1835246.042803 $8727794.6900 $4.7600
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Total 45589 1837044.373230 $8796169.2400 $4.7900
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Number of Children (Unduplicated) With at Least One Authorization 8771