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 98 129 39.181290 $1900.3500 $48.5000
AUDE -92552 PURE TONE AUDIOMETRY -AIR ONLY 30 30 6.277775 $81.9200 $13.0500
AUDE -92553 PURE TONE AUDIOMETRY AIR & BONE 1 1 0.505556 $8.4800 $16.7800
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 31 31 5.783331 $52.6800 $9.1100
AUDE -92567 TYPMANOMETRY (IMPEDANCE TESTING) 31 31 5.783331 $54.0100 $9.3400
AUDE -92579 VISUAL REINFORCEMENT AUDIOMETRY 30 30 5.277775 $114.6800 $21.7300
AUDE -92582 CONDITIONED PLAY AUDIOMETRY 1 1 0.505556 $12.7700 $25.2600
AUDE -92585 AUD EVOKED RESPONSE (DIAG) 9 10 1.738888 $99.0100 $56.9400
AUDE -92587 OTOACOUSTIC EMISSIONS (LIMITED) 22 22 3.211109 $78.5700 $24.4700
AUDE -AUDE UNSPECIFIED AUDE SERVICES 25 30 11.488889 $689.3300 $60.0000
AUDE -V5010 ASSESSMENT FOR HEARING AID 4 5 2.000000 $90.0000 $45.0000
AUDE -V5090 DISPENSING FEE PER HEARING AID 8 10 5.172223 $594.8100 $115.0000
EVAL -EVAL DEVELOPMENTAL EVALUATION 4 4 0.213698 $10.6900 $50.0200
EXIT -EXIT EXIT ASSESSMENT 97 97 16.215831 $810.7900 $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 2 2 0.022222 $1.6700 $74.9300
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 45 45 0.419853 $31.4700 $74.9500
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 3 3 0.016437 $1.2400 $75.2900
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 19 19 0.136524 $7.5900 $55.5700
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 11 11 0.092692 $6.9500 $75.0100
OCTF -97004 OT EVAL BY LICENSED OT, FOLLOW-UP 7 8 3.682541 $178.6100 $48.5000
OCTH -97003 OT EVAL BY LICENSED OT, INITIAL 103 113 36.204474 $1755.9500 $48.5000
PSTF -97002 EVAL BY LICENSED PT, FOLLOW-UP 4 5 0.716666 $34.7600 $48.5000
PSTH -97001 EVAL BY LICENSED PT, INITIAL 78 87 26.444453 $1282.6000 $48.5000
SPCH -92506 SPEECH EVAL BY LICENSED SLP 187 210 155.909909 $7561.7100 $48.5000
VISD -VISD VISION EVALUATION DIAGNOSTIC 1 1 0.355556 $35.5600 $100.0100
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Subtotal (Total Children Is Unduplicated) 633 936 327.364912 $15496.8100 $47.3400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 30 35 18.441936 $92211.5000 $5000.1000
AUD -HA_FUP AUDIOLOGY SERVICES 29 34 93.203979 $4660.2000 $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 2688 3810 6262.778334 $313137.9700 $50.0000
CONIP -CONIP CONSULT, ITDS, PHONE 61 73 140.016663 $3500.4100 $25.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 2333 3097 5328.812241 $266439.6300 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 21 26 36.705553 $917.6300 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 2232 2969 5054.831149 $252740.5700 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 24 29 50.500001 $1262.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 3580 4720 7081.723756 $354085.1300 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 46 51 93.436506 $2335.9100 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 24 24 197.650357 $4941.2500 $25.0000
EIIF -COUN UNSPECIFIED COUNSELING 1 1 0.533333 $26.6700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 1463 1962 14165.177417 $708258.6300 $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 2 2 18.714286 $935.7200 $50.0000
INTR -INTR INTERPRETER 67 99 737.825028 $36891.2400 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 249 316 1996.775003 $135541.0900 $67.8800
OCCT -97530HM OT SESSION BY OT ASST 3 4 17.750000 $964.1800 $54.3200
PHY -97110 PT SESSION BY LICENSED PT 274 343 2001.933934 $135891.3100 $67.8800
PHY -97110HM PT SESSION BY PT ASST 3 3 27.447619 $1490.9500 $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 7 7 2.769104 $1384.6500 $500.0400
SENS -HA_INS SENSORY AID INSURANCE PER EAR 8 9 5.153501 $334.9800 $65.0000
SENS -V5050 MED HEARING AID - ANALOG/DIGITAL 4 5 1.688889 $385.0700 $228.0000
SENS -V5264 EARMOLD 21 25 14.216670 $255.9100 $18.0000
SHIN -T1027SC INITIAL SHINE SERVICES, INDIVIDUAL 20 24 28.283333 $1414.1700 $50.0000
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 610 799 5155.505954 $349955.7300 $67.8800
SPL -92508 GROUP SPL SESSION PER CHILD 5 5 36.223810 $478.1600 $13.2000
TRAV -FLAT PROV TRAVEL TO NATL ENV $10 PER CHI 1718 2469 16437.900063 $164378.9500 $10.0000
TRAV -TRAV PROV TRAVEL TO NATURAL ENV PER MINU 4097 7535 1681453.321879 $840726.6800 $0.5000
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Subtotal (Total Children Is Unduplicated) 7177 29155 1746600.784201 $3683301.1700 $2.1100
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Total 30393 1747316.411009 $3698797.9800 $2.1200
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Number of Children (Unduplicated) With at Least One Authorization 7543